Chronic cardiac diseases and patients’ mental health: Exploring the impact of improving mental health on chronic heart failure prognosis and adherence to treatment behaviour in primary care based patients

Abstract

Introduction: Heart failure is a complex clinical syndrome. In this study, the clinical area of focus is chronic heart failure (HF). The average age of chronic HF onset is 77-years-of-age, with most patients likely to be exposed to polypharmacy and to display poor adherence to therapy. HF management depends upon symptomatic treatment and cardiac-respiratory rehabilitation. Chronic conditions are known to increase the risk of mental ill health, which can increase the risk of adverse cardiovascular outcomes and poor self-caring behaviour including poor adherence to therapy. Aim: This study aimed to explore whether improving mental health and medication adherence behaviour, could improve heart failure prognosis. Methods and design: This was a mixed-methods study, where HF patients were reviewed face to face at 3-monthly intervals. Consultations included screening for medication adherence, depression, and anxiety; diagnostics and laboratory results review, referral to specialist services as required, and conversation with the patients regarding their medical conditions and medications. Results: Non-adherence was present in 28% (n=17) of the cohort. The prevalence of depression and anxiety was 31.1% (n=19). There was a 14.7% improvement of baseline blood pressure over the course of 6-months. Smoking was identified to have a significant negative impact on blood pressure over the course of the study (p < 0.05). There was a significant improvement in mental illhealth, and medication adherence behaviour (p < 0.05). Depression was found to have a significant impact on overall wellbeing (p < 0.01). Depression and anxiety were also found to have a significant effect on medication adherence behaviour (p < 0.001 and p < 0.05), respectively. Conclusion: This study draws the attention to the need for introduction of a new pathway for the management of patients diagnosed with HF. It is recommended that there should be concurrent screening and management of the patients’ mental health, wellbeing, and adherence to therapy in addition to the traditional HF management.