Help My Heart but Don’t Forget My Mind: Facing Psychological Challenges of CHF Patients

Living with CHF is more than a medical condition; it's an emotional battle. Every day brings the weight of social isolation, constant fear, and the struggle to maintain a sense of control. It's not just about managing symptoms; it's about navigating a life that feels like it's slipping away.

These are the words of one of the CHF patients I had pleasure meeting while visiting hospitals during my clinical internship years as a psychology major. These thoughts stuck with me as they captured the psychological battle of living with not just CHF but all chronic diseases. I have seen the toll of managing ongoing battle that changes your lifestyle completely, yet as it has no cure you cannot help but feel is there a point in me fighting all of this?

Triggers of Psychological Change

There are two critical events in the life of CHF patient that trigger psychological change. The first critical event is the diagnosis, and the second one is or are hospitalizations. In these times patients find themselves in a vulnerable transiting stage and are subsequently at greater risk of adopting a negative attitude towards their new reality. At this stage patients need more protective factors around them such as social support from families and caregivers, doctor’s support and education, psychological help in facing the changes and embracing positive attitude.

During initial diagnosis mental health experts should help the patient work on acceptance of the new reality and commitment to change. Ideally, after diagnosis hospitalizations are prevented by adhering to the treatment and sustaining the new lifestyle. However, the devastating data suggests that 83% of CHF patients face hospitalization at least once a year, while 43% get hospitalized even 4 times a year for AHF episode¹. It is clear that problem in managing CHF persists. While a cure for CHF is not currently within reach, ongoing advancements in medical technology offer valuable tools for both patients and healthcare professionals to effectively manage heart failure. These include implantable assisting devices, wearables, fitness trackers, and pharmacological therapies.

Despite these efforts, persistently high hospitalization rates underscore the need for continued research and innovation in order to further enhance patient outcomes. However, one does not help but wonder, could the missing link be the lack of attention to the patient's psychological state?

After a thorough review of numerous CHF monitoring tools, a common theme emerges – patient adherence tends to decline over time. Modern digital solutions may offer convenience, yet they often fall short in effectively engaging patients, so the question remains: Is it possible that we can greatly enhance patient outcomes just by raising patient adherence to the treatment?

The Change and the Challenges

In the complex landscape of healthcare, the journey of patients dealing with heart failure is marked by various challenges that extend beyond physical symptoms. A significant factor influencing patient well-being is the notable decrease in adherence to treatment, often stemming from underlying issues with motivation, negative sentiments regarding chronic conditions, a perceived lack of control, social isolation, a sense of uncertainty about life's meaning, and an overall perception of low quality of life^2,3,4.

Remarkably, even hospitalizations, intended to address health concerns, can cast a shadow on a patient's well-being⁵. These hospital stays may inadvertently signal the progression of heart failure, reduced physical capacity, the onset of severe symptoms, and the potential threat of mortality. The negative messages conveyed during hospitalizations can significantly impact a patient's overall subjective well-being, creating a ripple effect that contributes to lower adherence to treatment due to diminished perceived self-efficacy.

Digging deeper into the complexities of this issue, factors such as the nature of hospitalization and personal interactions with hospital staff introduce heterogeneous effects on patients' well-being⁶. Recognizing the intricate link between mental health and physical well-being, clinicians have increasingly acknowledged the need to address emotional, behavioral, and social outcomes in heart failure patients. From a psychological perspective, the crux of effective solutions appears to lie in fostering a patient's intrinsic motivation, a goal achievable through the promotion of patient self-care⁷. This holistic approach not only recognizes the interconnectedness of mental and physical health but also strives to empower patients in their healthcare journey.

References

1. Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey Jr, D. E., Colvin, M. M., ... & Westlake, C. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 136(6), e137-e161. https://pubmed.ncbi.nlm.nih.gov/28455343/
2. Celano, C. M., Villegas, A. C., Albanese, A. M., Gaggin, H. K., & Huffman, J. C. (2018). Depression and anxiety in heart failure: a review. Harvard Review of Psychiatry, 26(4), 175. https://doi.org/10.1097/HRP.0000000000000162
3. Kovacs, A. H., Brouillette, J., Ibeziako, P., Jackson, J. L., Kasparian, N. A., Kim, Y. Y., ... & American Heart Association Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and Stroke Council. (2022). Psychological outcomes and interventions for individuals with congenital heart disease: a scientific statement from the American Heart Association. Circulation: Cardiovascular Quality and Outcomes, 15(8), e000110. https://doi.org/10.1161/HCQ.0000000000000110
4. Hodges, P. (2009). [Factors impacting readmissions of older patients with heart failure. Critical Care Nursing Quarterly, 32(1), 33-43. https://doi.org/10.1097/01.CNQ.0000343132.34942.64
5. Allen, L. A., Gheorghiade, M., Reid, K. J., Dunlay, S. M., Chan, P. S., Hauptman, P. J., ... & Spertus, J. A. (2011). [Identifying patients hospitalized with heart failure at risk for unfavorable future quality of life. ](https://doi.org/10.1161/CIRCOUTCOMES.110.958009 )Circulation: Cardiovascular Quality and Outcomes, 4(4), 389-398.
6. Buck, H. G., Dickson, V. V., Fida, R., Riegel, B., D’Agostino, F., Alvaro, R., & Vellone, E. (2015). Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care. International Journal of Nursing Studies, 52(11), 1714-1722. https://doi.org/10.1016/j.ijnurstu.2015.06.018
7. Nordfonn, O. K., Morken, I. M., Bru, L. E., & Husebø, A. M. L. (2019). [Patients’ experience with heart failure treatment and self‐care—a qualitative study exploring the burden of treatment. Journal of Clinical Nursing, 28(9-10), 1782-1793. https://doi.org/10.1111/jocn.14799