Psychological factors in heart failure. A review of the literature

Congestive heart failure (CHF) is the end stage of many diseases of the heart and a major cause of morbidity and mortality. The incidence of CHF is increasing steadily as treatment for its coronary antecedents, such as myocardial infarction, advances. Treatment of CHF generally relies on a battery of pharmacological interventions, alongside exercise and diet regimens. It is only in recent years that the psychological impact of heart failure has been explored, which is reflected by the absence of standardized psychological assessment for patients with CHF. In this article, we review studies that have addressed the effects of depression, anxiety, coping style, and level of social support in CHF. From the available evidence, it appears that patients generally experience moderate levels of depression, but not greatly heightened anxiety. Level of social support and style of coping with the disease are, however, important prognostic factors. It is difficult to draw definitive conclusions owing to the paucity of literature. Further work examining this issue is needed if the psychological issues of heart failure are not to be neglected.