Abstract
Objective
To review evidence regarding the prevalence, causation, clinical implications, aspects of healthcare utilisation and management of depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease.
Design
A critical review of the literature (1994โ2009).
Findings
The prevalence of depression and anxiety is high in both chronic obstructive pulmonary disease (8โ80% depression; 6โ74% anxiety) and chronic heart failure (10โ60% depression; 11โ45% anxiety). However, methodological weaknesses and the use of a wide range of diagnostic tools make it difficult to reach a consensus on rates of prevalence. Coโmorbid depression and anxiety are associated with increased mortality and healthcare utilisation and impact upon functional disability and quality of life. Despite these negative consequences, the identification and management of coโmorbid depression and anxiety in these two diseases is inadequate. There is some evidence for the positive role of pulmonary/cardiac rehabilitation and psychotherapy in the management of coโmorbid depression and anxiety, however, this is insufficient to guide recommendations.
Conclusions
The high prevalence and associated increase in morbidity and mortality justifies future research regarding the management of anxiety and depression in both chronic heart failure and chronic obstructive pulmonary disease. Current evidence suggests that multiโfaceted interventions such as pulmonary and cardiac rehabilitation may offer the best hope for improving outcomes for depression and anxiety. Copyright ยฉ 2009 John Wiley & Sons, Ltd.