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European Heart Journal Advance Access originally published online on March 19, 2008
European Heart Journal 2008 29(9):1208; doi:10.1093/eurheartj/ehn120
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Psychology and cardiology: do not forget the heart failure patient

Tiny Jaarsma

Department of Cardiology
University Medical Centre Groningen,
University of Groningen
PO Box 30,001
9700 RB Groningen
The Netherlands
Tel/Fax: +31 50 361 3429
Email: t.jaarsma{at}thorax.umcg.nl

Ivonne Lesman

Department of Cardiology
University Medical Centre Groningen,
University of Groningen
PO Box 30,001
9700 RB Groningen
The Netherlands

Dirk J. van Veldhuisen

Department of Cardiology
University Medical Centre Groningen,
University of Groningen
PO Box 30,001
9700 RB Groningen
The Netherlands

With great interest we read the article ‘Psychological treatment in cardiac patients: a meta analysis’ of Linden et al.1 The authors report a mortality benefit of 27% of psychological treatment in cardiac patients for at least the first 2 years and 43% reduction of event recurrence at follow-up longer than 2 years. Interestingly, no effects were found for women either on mortality or on morbidity.

Despite acknowledging the dangers of sub-analyses, the authors1,2 found several explanations why women do not experience a survival benefit from psychosocial interventions: women having more severe depression, less social support, and longer delay in seeking treatment since they did not want to bother others.

The meta-analysis did not include any heart failure patients but included only studies in patients after myocardial infarction, cardiac surgery, or percutaneous coronary intervention. No studies on psychological treatment are available in patients with heart failure (yet). However, with this letter we like to draw the attention to patients with heart failure and in particular women with heart failure. In a study analysing depressive symptoms in heart failure, we found that 40% report depressive symptoms with a significant gender difference of 47% in women and 36% in men.3 Patients with heart failure are vulnerable for hospitalization and mortality, which may even be worse in those with depressive symptoms. Exercise programmes might be beneficial for these patients; however, first, heart failure patients are often not referred to rehabilitation programmes and secondly female heart failure patients are often older and depend more on others for transportation and therefore do not enrol in these programmes.

We therefore fully support the conclusion of Dobbels2 to look for opportunities to stimulate psychosocial interventions in cardiac care in a broader perspective. For heart failure patients, this might be an integrated component in a disease management programme at a heart failure clinic.4 We know that there is no ‘one size fits all’ heart failure disease management programme,5 but as we are facing a growing population of older (often female) heart failure patients, effective interventions need to be developed addressing the broad range of medical and psychological problems that effect mortality and morbidity.

References

  1. Linden W, Philips J, Leclerc J. Psychological treatment in cardiac patients: a meta-analysis. Eur Heart J (2007) 28:2972–2984.[Abstract/Free Full Text]
  2. Dobbels F. Does every cardiologist need a psychologist? Eur Heart J (2007) 28:2964.[Free Full Text]
  3. Lesman-Leegte I, Jaarsma T, Sanderman R, Linssen G, van Veldhuisen DJ. Depressive symptoms are prominent among elderly hospitalised heart failure patients. Eur J Heart Fail (2006) 8:634–640.[CrossRef][Web of Science][Medline]
  4. van der Wal MHL, Jaarsma T, van Voorst R. Psychiatric nurse; member of the HF management team? Eur J Cardiovasc Nurs (2005) 4:99–100.[CrossRef][Medline]
  5. Jaarsma T, van der Wal MHL, Lesman I, Luttik ML, Hogenhuis J, Veeger N, Sanderman R, Hoes AW, van Gilst WH, Lok DJA, Dunselman PHJM, Tijssen JGP, Hillege HL, van Veldhuisen DJ. Effects of moderate or intensive disease management program on outcome in patients with heart failure. Results from the COACH trial. Arch Intern Med (2008) 168:316–324.[Abstract/Free Full Text]

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
29/9/1208    most recent
ehn120v1
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