Depression and anxiety in patients with chronic heart failure

Chronic heart failure (CHF) is a progressive, debilitating disease, resulting in a decline in the quality of life of the patients and in very high social economic costs. CHF is a complex disease, whose diagnosis is made based on physical examination of the patient by the physician, and based on medical history including symptoms such as congestion and/or hypoperfusion of the organs [1]. It is defined as the inability of the heart to supply the oxygen demands by the peripheral organs, causing negative effects on all the body systems [2]. Patients affected by CHF often have a low quality of life, and most of the patients have a short life expectancy, with high mortality rate within 5 years from diagnosis [3]. Current data estimate that 5.8 million people in America are currently affected, and about 23 million people worldwide. However, considering that the average age of the population is rising thanks to advances in the medical treatment for cardiovascular diseases, the number of patients diagnosed with CHF is expected to increase in the coming years [4]. Fatigue and intolerance to exercise are the most obvious clinical manifestations in patients with CHF [5]. Other comorbidities are commonly observed, such as depression and anxiety [6]. The focus of the present article is to discuss the potential correlation between the above-mentioned comorbidities, CHF and the diaphragmatic innervation and functionality. It has been demonstrated that some psychiatric behaviors can have impact on the survival rate, as discussed in the paragraphs below. In this article the authors hypothesize that the dysfunction of the diaphragm often detectable in this chronic condition can have a role in the occurrence of these comorbidities. In the field of respiratory and cardiac rehabilitation, it has been demonstrated that an improvement of the respiratory activity can lead to an improved emotional status