Psychosoziale Faktoren bei Herzinsuffizienz: Mehr als eine Komorbidität?

Several psychosocial factors increase the incidence of congestive heart failure (CHF) and worsen the course of the disease. However, in clinical practice psychosocial factors are generally less taken into account than somatic factors. The former include depression, anxiety disorders, and cognitive changes, whose prevalence may be as high as 60 percent in CHF, as well as socioeconomic status and poor social support. These psychosocial factors not only reduce the health-related quality of life and have a negative impact on adherence, but also increase morbidity and mortality in CHF. The diagnosis can be made using simple instruments (e. g. targeted questions and/or validated questionnaires).

Besides psychotherapeutic treatment modalities psychotropic drugs may be required. However, the potential side-effects of the latter have to be considered (e. g. induction of life threatening arrhythmias). Several antidepressants, such as lithium and tricyclic antidepressants, are contraindicated in CHF. SSRI are thought to be safe and to relief symptoms, however, their prognostic benefit has yet to be demonstrated in CHF. A holistic approach with intensified individualized medical support including psychosomatic basic care appears to be of utmost importance which may require further support by psychotherapists, psychatrists, specifically qualified nurses and sport and movement therapists.

Thieme E-Journals – Kardiologie up2date / Abstract

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