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Low Rates of Psychotherapy Referrals in Patients With Heart Failure With Depression

Published:December 12, 2022DOI:



      Depression is common among patients with heart failure (HF) and can impact patients’ outcomes. In this study, we evaluated the rates of psychotherapy referrals for patients with HF with depression.

      Methods and Results

      Using the National Ambulatory Medical Care Survey from 2008 to 2018, we examined visits for patients with depression and concurrent HF or coronary artery disease. We estimated the likelihood of referral for psychotherapy using survey weights to provide nationally representative estimates. Among 1797 visits for patients with HF or coronary artery disease and depression, only 9.4% (95% confidence interval 7.2%–12.2%) were referred for psychotherapy, including mental health counseling and stress management. Rates of referral were lowest among patients with depression and HF at 7.5% (95% confidence interval 4.1%–13.2%). The odds of referral decreased over the years from 2008 to 2018 (odds ratio per additional year 0.87, 95% confidence interval 0.77–0.98, P = .022), with referral rates in 2008 of 12.8% compared with 4.8% in 2018.


      In this nationally representative study of ambulatory visits, patients with HF and depression were referred for psychotherapy in only 7.5% of visits and referral rates have decreased over the years. Magnifying the value of psychotherapy and increasing referral rates are essential steps to improve care for patients with HF with depression.

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