Relaxation Response for Veterans Affairs Patients With Congestive Heart Failure: Results From a Qualitative Study Within a Clinical Trial

A number of studies have demonstrated a relationship between depression and low perceived social support and increased cardiac morbidity and mortality in patients with coronary heart disease. There is also evidence that depression increases the risk of acute myocardial infarction and morbidity and mortality following it. This review examines those studies that have investigated these relationships as well as those that have attempted to explain them on the basis of various pathophysiologic mechanisms. Among the latter are studies that have shown that selective serotonin reuptake inhibitors are beneficial in the treatment of depression and that they appear to reverse the enhanced platelet activity observed in depressed patients with acute myocardial infarction. Depression increases hospital length of stay, procedures, readmission rates, and the cost of medical care. Much remains to be elucidated concerning the roles of depression and low perceived social support in predisposing to acute myocardial infarction and to increased morbidity and mortality following it. However, sufficient scientific evidence exists for physicians to make efforts to diagnose and treat depression to reduce the concurrent risk of acute myocardial infarction and morbidity and mortality following it.