Expert opinion of the Heart Failure Association of the Polish Cardiac Society and the Polish Psychiatric Association on management of patients with heart failure and selected mental disorders (depression, anxiety disorders, sleep disorders, delirium)

The most common mental disorders in patients with heart failure (HF) include depression, anxiety disorders, and sleep disorders, and in hospitalized HF patients - delirium. In patients diagnosed with HF, depression and anxiety are associated with an increased incidence of HF-related hospitalization and mortality. The vast majority of people with HF report poorer sleep quality and/or insomnia symptoms, which are associated with a decrease in exercise capacity and raise the risk of HF development. Delirium typically occurs in the course of acute HF, most often as hyperactive delirium. The occurrence of delirium in patients with acute HF adversely affects prognosis. The basic pathophysiological mechanisms linking mental disorders with HF include oxidative stress, stimulation of the sympathetic nervous system, and immune system dysregulation. Validated scales and questionnaires accepted by the Polish and European Psychiatric Association are applied to diagnose mental disorders. Basic antidepressants belong to selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and drugs with other mechanisms of action. In addition to pharmacotherapy, psychological and psychotherapeutic interventions, psychoeducation, stress management, and relaxation training, as well as spiritual care, can also be applied. If the needs are more complex, palliative care should be considered at any stage of life with the disease, not only as end-of-life care. The treatment of delirium, especially in hospitalized elderly patients, remains a challenge. This opinion defines the competencies of cardiologists and psychiatrists in treating mental disorders in HF patients and indicates how to manage patients in their treatment process. Diagnosis of mental disorders is essential for the appropriate treatment and improvement in the prognosis for HF patients.