Psychosocial Issues in Patients With Congestive Heart Failure

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´╗┐Psychosocial Issues in Patients With Congestive Heart Failure
Psychosocial issues are important variables that need to be addressed in patients with congestive heart failure (CHF). Unfortunately, these issues are often overlooked. Depression and lack of social support have been shown to have a negative impact on patients with CHF. Patients with CHF who are depressed or who lack social support have been shown to have increased morbidity and hospital readmission rates, to be less adherent to their medical regimen, and to have an overall increase in cost of care. The variables are often interrelated, as high levels of social support may lessen the impact of depression on mortality. In addition, certain biologic factors may influence the impact of psychosocial factors in patients with CHF. This review addresses the effects of depression, treatment adherence, and social support in patients with CHF and suggests interventions targeted to these problems. Health care professionals must assess these issues in all patients with CHF, address their specific needs, and intervene appropriately when warranted.

Congestive heart failure (CHF) affects more than 5 million Americans. It is the most common cause of hospitalization in the Medicare population. Readmissions for CHF occur in 29%-50% of elderly patents at 3-6 months after initial hospital discharge. Economically, CHF is currently the most costly health care problem in the United States, and the cost is rising. The number of patients with CHF is increasing because the US population is aging and because treatments for underlying conditions that cause CHF such as coronary heart disease (CHD) and hypertension are improving, thus increasing patient survival.

In addition to the physiologic aspects, health care professionals should consider psychosocial issues in patients with CHF. Psychosocial issues such as depression and lack of social support are often neglected by health care professionals, and may lead to poor clinical outcomes. There is strong evidence linking depression and lack of social support to adverse cardiac outcomes in patients with CHD. Many findings in patients with CHD are relevant to patients with CHF because more than one half of patients with CHF have underlying CHD, and the two conditions often have shared characteristics. It has been recently shown that abundant social support for patients with CHD may mollify the impact of depression on mortality following myocardial infarction (MI). In addition, patients with depression or lack of social support may not adhere to their prescribed medical regimen, thus increasing morbidity.

From a contributory but different perspective, there are biophysiologic responses that occur in response to depression and lack of social support which may contribute to the pathogenesis and end results of heart disease and CHF. The purpose of this review is to discuss how depression, adherence to medical therapy, and lack of social support affect patients with CHF, and to suggest interventions targeted to these issues.

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