Guideline-directed heart failure pharmacotherapy and depression/anxiety: a scoping review of heart failure and related cardiovascular populations

BACKGROUND: Heart failure is a chronic and progressive condition affecting millions worldwide, often accompanied by psychological comorbidities such as depression and anxiety. These conditions adversely impact quality of life, treatment adherence, and prognosis. Understanding how pharmacologic therapy influences mental health is essential for comprehensive care. METHODS: A scoping review was conducted using PubMed and other databases to identify studies published between 2000 and 2024 assessing the effects of heart failure treatments on depression and anxiety. Seventy studies, including randomized controlled trials and observational analyses, met the inclusion criteria. This scoping review was conducted in accordance with PRISMA-ScR guidelines. RESULTS: Findings revealed heterogeneous and often indirect associations between heart failure pharmacotherapies and mental health outcomes. Beta-blockers showed variable associations, with some studies reporting depressive symptoms potentially influenced by fatigue and sleep-related side effects. ACE inhibitors and ARBs have been associated with lower depression and anxiety symptom scores in some cohorts, though findings are heterogeneous and of uncertain clinical significance. ARNI therapy has been associated with improvements in quality-of-life measures that include mental health domains, while direct effects on depression and anxiety remain uncertain. Evidence for MRAs, diuretics, nitrates, and SGLT-2 inhibitors was limited or mixed, with mental health outcomes rarely assessed as primary endpoints. CONCLUSIONS: Current evidence suggests heterogeneous and largely non-causal associations between heart failure pharmacotherapy and mental health outcomes. Observed relationships may reflect improvements in heart failure symptoms and quality of life rather than direct neuropsychiatric effects. These findings underscore the importance of integrated psychocardiology approaches and highlight the need for heart failure–specific studies using standardized mental health endpoints.