Evaluation and treatment of depression in patients with heart failure

Abstract

PURPOSE: The purpose of this article is to provide an overview of relevant clinical issues including pathophysiology, clinical presentation, assessment/diagnosis, and treatment strategies regarding depression in the heart failure (HF) patient. This information was synthesized to create a clinical protocol to guide the practitioner in identifying, diagnosing, and treating depression in adult HF patients. This protocol was designed for use in the primary care or HF clinic setting. DATA SOURCES: PubMed and CINAHL were utilized to search for articles pertaining to HF and depression. CONCLUSIONS: The presence of depression in HF is associated with a worsening prognosis, increased risk of death, rehospitalization, and functional decline. The practitioner must identify predisposing factors for depression and evaluate symptoms. Self-rated screening instruments can assist the practitioner in identifying those with depression. Evidence is lacking regarding the treatment of depression in HF but selective serotonin reuptake inhibitors are likely the best option. IMPLICATIONS FOR PRACTICE: Understanding depression as it occurs in patients with HF is critical. If depression is identified and properly managed it may lead to better patient outcomes.