Objective:
The aim of this prospective study was to examine the prevalence, recognition, and treatment of depression and anxiety in ambulatory patients with heart failure.

Method:A total of 158 heart failure participants were enrolled between November 2006 and April 2007. Each patient completed a telephone screening interview that included an assessment of heart-failure severity (New York Heart Assciation criteria) as well as measures for depression (Geriatric Depression Scale [GDS]) and anxiety (Geriatric Anxiety Inventory [GAI]). Following study recruitment, each patient’s electronic medical record was comprehensively reviewed for the 12 months prestudy and 6 months poststudy assessments to determine whether patients had been recognized as having and/or treated for depression or anxiety.

Results:Prevalence of depression (GDS score ≥ 6) was 41.8%, and prevalence of anxiety (GAI score ≥ 9) was 25.3%. Of patients with a positive GDS or GAI result, 57.5% had a diagnosis or medical-record notation for depression and/or anxiety, and 60.3% received mental health treatment during the 18-month period of the EMR review.

Of patients with a documented diagnosis of depression or anxiety, 92.3% received mental health treatment. Results showed that higher GDS scores were associated with recognition of depression/anxiety in the medical record, and a positive primary care depression screening predicted documented mental health treatment.

Conclusion: These data suggest that symptomatic depression and anxiety are underrecognized in heart failure patients and that mental health screening may be important for receipt of care. Notably, once depression and/or anxiety was documented in the medical record, patients were highly likely to receive mental health treatment.

Chronic illnesses, especially illnesses that severely affect functional abilities, such as heart failure (HF), are associated with significant physical, psychological, and lifestyle changes that often lead to increased mental health difficulties.  The prevalence of depression and anxiety is far greater among chronically ill persons than among the general primary care population,  with prevalence ranging from 30% to 50% in persons with HF.

The impact of anxiety and depression is pervasive and can reduce patients’ ability to cope with physical symptoms and adhere to medical treatment. The combination of depression and/or anxiety with a chronic medical illness also leads to increased risk of mortality, worsening of quality of life, functional disability, and increased health care utilization and cost.

Unfortunately, the rates for detecting and treating depression and anxiety among those with medical illnesses are quite low. Poor recognition and treatment of depression and anxiety may complicate and exacerbate HF symptoms, precipitate functional decline, disrupt social and occupational functioning, and lead to an increased risk of mortality.

A host of barriers, including patient, provider, and systems factors, likely affect poor recognition and limited treatment for depression and anxiety, especially in medical care settings. As examples, barriers include negative patient expectations about mental health conditions and/or treatment, physician competing demands and/or limited mental health knowledge, and restricted availability of mental health resources.

Although there is increasing information on the prevalence and impact of depression (and, to a lesser extent, anxiety) in the medically ill, few studies have examined rates of identified and treated mental health conditions, and no known studies have examined mental health recognition and treatment for outpatients with HF. The current study focused on ambulatory HF patients to (1) examine patient self-reported prevalence for depression and anxiety, (2) review electronic medical records (EMRs) to examine rates of system-level recognition and treatment of depression and anxiety over an 18-month extraction period, and (3) predict system-level recognition and treatment using patient demographic and clinical factors.