The diagnosis of heart failure and living with heart failure can have a significant psychological impact. This can lead to :

• Avoidant behavior.
• Fear.
• Processing problems.
• Social inhibition and isolation, decrease in social contacts.
• Physical inhibition: no longer daring to do physical efforts.
• Gloom, depression.
• Sleep disorders.
• Decreased libido and sexual problems.

Patients with a “Type D personality” (D for “distressed”) are particularly at risk for this.

These conditions can :

• Significantly reduce quality of life.
• Compromise patient self-care and compliance. This can be further worsened by reduced cognitive function, poor comprehension of information, or low literacy.

Timely detection and, if necessary, referral of the patient for appropriate help is important.

In the case of cardiomyopathies caused by substance abuse (alcohol, cocaine, etc.), a targeted referral for detoxification is indicated.

In addition, smoking cessation guidance by a tobacco treatment specialist is an essential part of optimizing lifestyle in heart failure.

• Psychosocial support is very important.
• Selective serotonin reuptake inhibitors, SSRIs (e.g. escitalopram, sertraline) are generally safe in patients with heart failure, but there is a risk of :
  • Prolongation of the QTc interval, torsades de pointes and sometimes sudden death! The QTc interval should be monitored, especially if taken in combination with amiodarone or other QTc prolonging medications, in case of hypokalemia, etc.
  • Hyponatremia during therapy. The natremia must be monitored.
• TCA (tricyclic antidepressants) should be avoided as they cause a higher risk of arrhythmias, hypotension, and progressive heart failure.

• CGG (‘mental health care center”) or CAW (‘Centrum Algemeen Welzijn’: “general welfare center”) :
  • Psychotherapy for serious psychological difficulties, based on referral
  • long-term waiting list
  • Combination with social or societal difficulties
  • Reserved for patients with little financial capacity

• Primary care psychology :
  • Government-subsidized psychologists
  • Possible further expansion in healthcare
  • Referral from the doctor or GP is a condition
  • Options per region
  • Waiting list within a reasonable period of time
  • Psychological advice or short-term help (8 sessions/year)
  • Costs for the patient: 11 euros per session

• Psychotherapy by psychologists on an independent basis :
  • Long-term therapeutic follow-up possible
  • Limited reimbursement linked to health insurance
  • Costs are higher for the patient: 55-75 euros per session

• Psychotherapy in multidisciplinary cardiac rehabilitation.

• Cooperation
• Processing
• Psychoeducation
• Structuring
• Emotion regulation

In concrete terms: a psychologist can provide support with, for example:

• The coping process and learning to deal with the disease (coping).
• Learning techniques to deal with anxiety or stress.
• Lifestyle adjustments (including smoking cessation or withdrawal from substance abuse (alcohol, drugs)).
• Relational tensions or questions surrounding sexuality and intimacy, for example through couples' therapy.

Some patients struggle with persistent feelings of depression or anxiety, which may require referral to a psychiatrist. A psychiatrist can prescribe medication or other treatment if necessary.