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Depression and anxiety more common in heart failure than cancer patients

Risk Factors and Prevention
Depression and Heart Disease
Heart Failure

Sophia Antipolis, 14 May 2021:  Nearly one in four patients with heart failure is depressed or anxious, according to a study published during this week’s Heart Failure Awareness Days. Patients with heart failure were 20% more likely to develop these mental health issues during the five years after diagnosis compared to those with cancer. The findings are published in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).1

“The treatment of mental illnesses in cancer patients – psycho-oncology – is long-established but similar services for heart patients (psycho-cardiology) are still in their infancy,” said study author Dr. Mark Luedde of the Cardiological Group Practice, Bremerhaven, Germany. “Our study suggests that heart failure patients could benefit from greater support with psychological problems.”

Heart failure affects around 65 million people worldwide2 and is more deadly than some cancers.3 The number of co-existing conditions in heart failure patients is also rising,4 and they are connected with poorer quality of life.5 This study examined how often depression or anxiety occurred in the course of heart failure compare with various cancers.

The study used information from the nationally representative German Disease Analyzer database, which includes approximately 3% of outpatient practices. The researchers compared the combined incidence of depression and anxiety during the five years after a diagnosis of heart failure or cancer.

The retrospective analysis included adults with an initial diagnosis of heart failure, breast cancer, prostate cancer, or digestive organ cancer in 1,274 general practices between 2000 and 2018. This was a total of 96,772 patients with heart failure, 21,261 patients with breast cancer, 16,478 patients with prostate cancer, and 29,479 patients with cancer of the digestive organs.

Within five years after diagnosis, 23.1% of heart failure patients had developed depression or anxiety compared to 25.7%, 22.1%, and 15.0% of patients with breast, digestive, and prostate cancers, respectively.

When compared to overall cancer, heart failure patients had a significantly higher risk of developing depression or anxiety with a hazard ratio of 1.20 (95% confidence interval 1.18–1.23; p<0.001). More specifically, the risk of depression or anxiety for heart failure patients was 66% higher than those with prostate cancer and 17% higher than those with gastrointestinal cancer. Risks of depression and anxiety were similar between heart failure patients and those with breast cancer.

In all four groups, the incidence of depression and anxiety increased continually over the five years of follow-up.

Dr. Luedde said: “The high incidence of depression and anxiety in heart failure patients shows the importance of these problems. While we did not investigate the causes of mental health issues, the even higher occurrence in those with breast cancer may be connected to a fear of recurrence. The rising incidence of psychological problems over time in both heart failure and cancer could be due to limitations on daily activities caused by fatigue, impaired mobility, and other debilitating symptoms.”

Dr. Luedde concluded: “Psychological support services for patients with cancer are relatively common. However, more help is needed for those with heart failure – of whom almost one-quarter develop depression or anxiety after their diagnosis.”


Notes to editor

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Funding: None.

Disclosures: None.


1Loosen SH, Roderburg C, Jahn JK, et al. Heart failure and depression: a comparative analysis with different types of cancer. Eur J Prev Cardiol. 2021. doi:10.1093/eurjpc/zwab048.

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2Bragazzi NL, Zhong W, Shu J, et al. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol. 2021. doi:10.1093/eurjpc/zwaa147.

3Mamas MA, Sperrin M, Watson MC, et al. Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. Eur J Heart Fail. 2017;19:1095–1104.

4Conrad N, Judge A, Tran J, et al. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet. 2018;391:572–580.

5Lawson CA, Solis-Trapala I, Dahlstrom U, et al. Comorbidity health pathways in heart failure patients: A sequences-of-regressions analysis using cross-sectional data from 10,575 patients in the Swedish Heart Failure Registry. PLoS Med. 2018; 5:e1002540.


About the European Society of Cardiology

The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.

About the European Journal of Preventive Cardiology
The European Journal of Preventive Cardiology is the world's leading preventive cardiology journal, playing a pivotal role in reducing the global burden of cardiovascular disease.