Heart disease and mental well-being: what about heart failure?

Heart failure causes physical symptoms that may have an impact on your well-being, as well as feelings and emotions such as sadness, anxiety, or depression.

What is the emotional response to heart failure?^1-4

Emotional stress is common in patients with heart failure, due in part to the complexities of effective disease self-management and progressively worsening functional limitations, including frequent symptom exacerbations and hospitalizations. 

Studies show that heart failure patients who experience higher levels of emotional stress may have a more burdensome disease course, with diminished quality of life and increased risk for adverse events. Furthermore, the reduced quality of life associated with heart failure can serve as a life stressor for many patients. 

Heart failure can affect mental health. It can cause temporary feelings of: 

• Sadness 

• Fear 

• Discouragement 

• Confusion 

• Frustration 

• Anger 

• Anxiety 
• Low mood

But in some people, it may also contribute to, or worsen mental health conditions, such as depression. 

Studies show that the rates of depression and anxiety are higher in people with heart failure than in the general population:  

• 21.5% of heart failure patients have symptoms of depression 

• 13% have symptoms of generalized anxiety disorder 
• Nearly 30% have significant levels of anxiety of any type

What are the consequences of the emotional response to heart failure?² 

The emotions felt by heart failure patients may come and go at varying points over time as the person adjusts to new aspects of their life, such as: 

• Taking new medications 

• Experiencing side effects from drugs 

• Making frequent follow-up visits to the doctor

These emotions may naturally dissipate. In some cases, they may persist, even if a person starts feeling physically better. If the feelings persist, a person could have depression, anxiety disorders, or a post-traumatic stress disorder. 

Depression due to an emotional response to heart failure² 

Depression is a sustained low mood that comes with physical changes and whose symptoms include: 

• Persistent sadness 

• Feelings of hopelessness or worthlessness 

• Loss of interest in activities 

• Irritability or restlessness 

• Tiredness or lack of energy 

• Changes in appetite 

• Changes in sleep 

• Talking or moving slowly 
• Difficulty concentrating or making decisions 

With severe depression, heart failure patients may have suicidal thoughts or behaviors. It is worth noting that heart failure could potentially worsen depression symptoms that a person already has. 

If you know someone at immediate risk of self-harm, suicide, or hurting another person: 

• Ask the tough question: “Are you considering suicide?” 

• Listen to the person without judgment

• Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor 

• Stay with the person until professional help arrives 
• Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so 

Anxiety disorders due to an emotional response to heart failure

Anxiety disorders cause persistent or recurring worry or anxious thoughts. Symptoms can include: 

• Feeling tense 

• A sense of dread, danger, or panic 

• Raised heart rate or blood pressure 

• Sweating 

• Dry mouth 

• Choking sensation 
• Shaking or trembling

Post-traumatic stress disorder due to an emotional response to heart failure 

Post-traumatic stress disorder is a condition that may develop after a traumatic event, which can include any experience a person perceives as dangerous or life threatening. Heart failure may worsen post-traumatic stress disorder as part of a bidirectional relationship between the heart and brain. The symptoms of post-traumatic stress disorder are as following: 

• Feeling alert or unable to relax 

• Insomnia 

• Nightmares 

• Flashbacks, which could be emotional or visual 

• Avoidance of triggers, such as certain people, places, or situations

Coping with the emotional impact of heart failure disease^1,2 

By recognizing that these emotions are a normal part of adjusting to your condition, you can take positive steps that can help you feel better. Learning how to manage feelings is an important aspect of managing your heart failure, along with the use of effective medicines and adopting a healthy lifestyle. 

After diagnosis

To manage the emotional response to heart failure, the following positive steps may help: 

• Taking time to process the news 

• Acknowledging whatever feelings that come up 

• Expressing emotions, which could involve talking with someone you trust - such as your partner, a close family member or a friend -, journaling, or therapy 

• Asking your family and friends for support 

• Taking a more active role in managing your heart failure by learning more about your condition. 

It may also help to join a support group to talk with people who have had similar experiences and issues. 

Mental health treatment

In the case of symptoms of depression, anxiety, or post-traumatic stress disorder after the diagnosis, a treatment may be considered. This one may involve medications, talk therapy, or a combination of both. 

Self-care

Self-care involves managing emotions and caring for physical needs as best as possible. What this involves will look different from person to person. It may include: 

• Safely getting some exercise: feeling better physically can reduce depression and anxiety 

• Remembering to drink water 

• Eating regular meals 

• Making time to connect with friends or family 

• Getting enough sleep 

• Celebrating small wins 

• Spending time in nature or with animals 

• Getting involved in new activities that you can enjoy, and can give you a new outlook on life 

• Making jokes or seeing the lighter side of your situation, humor often being a great healer 

• Taking your medication consistently.