Commentary on "Depression and Anxiety Symptoms Are Associated With Reduced Dietary Adherence in Patients With Heart Failure Treated With an Implantable Cardioverter Defibrillator"

Kudos to these authors for investigating a very important topic. Despite the growing number of patients with heart failure who receive implantable cardioverter defibrillators (ICDs), we have little information available about this group, especially whether their responses and outcomes are similar to or different from those of patients with heart failure who have no ICDs. There are important take-home messages from this study, and there are a few additional considerations about the study for clinicians to think about when interpreting the findings. As with other studies in patients with heart failure, depression and anxiety were common in this sample of patientsVdepression occurred in about one-quarter of the sample and anxiety occurred in about one-third. Findings from this study suggest that the presence of anxiety and depression may explain patients’ nonadherence to diet recommendations. Furthermore, findings indicated that patients who were older, married, and of Caucasian descent had higher dietary adherence scores. Thus, as clinicians, we should consider targeting diet-related interventions to patients who are anxious or depressed and to those younger, single patients not of Caucasian descent. I am already thinking of patients in my practice who fall into one or more of these categories (some patients are in many categories! ) and how our clinic team can better interface with these patients and their families to assist them with these lifestyle issues. Another key message from this article is that approximately two-thirds of patients reported that they followed diet recommendations most or all of the time. Important to remember here is that this information is based on self-report of perceived (not actual) knowledgeVso we do not really know the dietary knowledge that the patients had nor whether they were accurately reporting their behavior. However, one wonders why there was such a high incidence of adherence. Was it because of the high level of social support reported by this sample? Although social support was not a significant predictor of adherence in this study, the authors speculate that this may have been because only 8% of the sample reported low social support. Diet adherence requires a significant amount of support in terms of choosing, shopping, and preparing appropriate foods. Perhaps patients in this study received enough support to perform these actions and thus to better adhere to recommendations. Another consideration when reviewing this study is that we do not know certain information that may affect our interpretation of the findings. For example, it is unknown what medications the patients were taking, especially diuretics and psychiatric medications. We do not know the proportions of patients who had ICDs implanted for primary or secondary prevention (which in theory could affect anxiety and/or depression levels). It is unknown if patients had other comorbidities that may have affected their responses to study questionnaires. We also do not know how patients were diagnosed as having heart failure and whether these patients had ever experienced episodes of volume overload.