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Tiny Jaarsma, Ivonne Lesman, Dirk J. van Veldhuisen, Psychology and cardiology: do not forget the heart failure patient, European Heart Journal, Volume 29, Issue 9, May 2008, Page 1208, https://doi.org/10.1093/eurheartj/ehn120
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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.
