Mental health and cardiovascular disease consensus statement: key messages

The first ESC consensus statement on Mental Health and Cardiovascular Disease1 was presented as a ‘call to action’ to increase awareness of the interaction between mental and cardiovascular health and disease, the impact of mental health conditions on cardiovascular risk and mortality in patients with and without cardiovascular disease (CVD), encourage research and the implementation and testing of screening and management interventions to improve mental health in practice (Figure 1). The statement followed the same process as Clinical Practice Guidelines, except that it does not provide formal recommendations for practice. Suggested actions are summarized as Management Consensus Statements at the end of each section and reflect the expertise of the Task Force and available evidence. Mental/cardiovascular health and disease interactions, and future directions. Reprinted with permission from Oxford University Press Multiple topics are discussed, from multi-directional interaction between mental and cardiovascular health and disease and collaboration with mental health professionals to create ‘Psycho-Cardio teams’, to a process for screening people with CVD for mental health conditions, and a stepped-care approach for management of mental health conditions utilizing psychological and medical interventions. The consensus statement reviews prevention and management of CVD in people with severe mental illness and considerations based on characteristics such as sex, gender, age, frailty, socioeconomic status, comorbidities, and medications. Caregivers of people with CVD play a key role in patients’ well-being and treatment adherence and may need support for mental health conditions themselves. Key points from the statement: The interaction between mental and cardiovascular health and disease should be known and acknowledged to provide holistic, integrated care. Mental health conditions are associated with stigma, worse CVD prevention and management, and worse outcomes. Mental health professionals should be added as collaborators to multidisciplinary teams to create psycho-cardio teams tailored to local needs. Screening for mental health conditions and psychosocial risk factors could help improve CV risk assessment in healthy individuals. Screening for mental health conditions in people with CVD is important since these are highly prevalent but may be overlooked. Initial screening may be performed by any member of the psycho-cardio team with a 1-minute, 2-item measure, followed by more comprehensive valid tools if positive. A stepped care approach for managing mental health conditions in persons with CVD is advisable: intensity of care should be tailored to individual need, preferences, and system. Psychological interventions improve depression, anxiety, quality of life, and CV outcomes. Pharmacological treatment should be balanced against risks, considering drug interactions and side effects, avoiding the overuse of benzodiazepines. People with SMI have high CV risk and need better prevention and management of CVD. The ESC Consensus Statement on Mental Health and Cardiovascular Disease calls for an increased awareness of the interaction between mental and cardiovascular health and disease, and advises on pragmatic steps to improve care for people with mental health conditions and CVD. Some steps can be integrated quickly into practice, but others will require longer-term changes to systems of care. Given the prevalence and impact of mental health conditions among people with CVD, we owe it to our patients to begin now. Christi Deaton declares that she has received research funding from Evelyn Trust Charity, National Institutes of Health Research and consulting fees from Astra Zeneca. Hector Bueno has received research funding from Instituto de Salud Carlos III (ISCIII), Sociedad Española de Cardiología, European Union, Boehringer-Ingelheim, Janssen-Cilag, Novartis, and Astrazeneca, and payments for consulting and speaking from Organon, Astra Zeneca, Novartis, Novo-Nordisk.