Heart failure can affect your quality of life by reducing your independence and ability to do some daily activities. As a result of these changes in your life, you may experience depression, anxiety, anger, loss of control, uncertainty, and feeling like a burden to others. Such feelings can be distressing and affect your overall wellness. By recognizing these emotions and where they come from, you can take positive steps to have better control. Understanding the emotions that result from a heart failure diagnosis will help you to manage life with this condition.

This module will provide information on:

• Feelings people can have after they are diagnosed with heart failure.
• Why managing feelings is part of a successful heart failure treatment plan.

It will help you:

• Recognize feelings of depression, anxiety, and anger.
• Develop strategies to help you manage feelings of depression and anxiety.
• Learn when to seek professional help for these feelings.

It is common for people to feel depression, anxiety, anger, loss of control, uncertainty, and feeling like a burden to others after being diagnosed with a chronic disease such as heart failure. Some people’s feelings may decrease or even go away after learning more about heart failure. For others, however, these feelings may continue or worsen over time. For people struggling with their emotions, there are ways to take control and have a good quality of life.

Emotions can affect recovery from heart failure and also increase risk of future heart failure hospitalizations. For this reason, it is important to understand your feelings and get professional help if you need it. It is normal to experience intense emotions when there is uncertainty about how a diagnosis will impact your day-to-day living. However, lasting depression, anxiety, and/or anger can lead to an imbalance of hormones, which are substances produced by your body that can make heart failure worse.

Patients with heart failure often feel anxious and may experience symptoms of depression. Everyone feels anxious or blue sometimes. However, when
these feelings do not go away, they can interfere with sleep, appetite, and energy level.

Although fatigue and loss of appetite are common symptoms of heart failure, they are more likely due to depression if accompanied by any of the symptoms listed below. Common symptoms of depression include having any of the following for more than two weeks:

• Down mood
• Feeling blue
• Trouble concentrating
• Loss of interest in things you used to enjoy
• Withdrawal from others
• Excessive sleepiness
• Feeling worthless or guilty
• Hopelessness
• Suicidal feelings
• Preoccupation with death
• Fatigue
• Loss of interest in sex
• Loss of appetite

Symptoms of anxiety are normal reactions to stressful situations. Common symptoms of anxiety are having any of the following for more than two weeks:

• Excessive worry
• Fear
• Tension
• Feeling keyed up or always on edge
• Restlessness
• Feeling shaky

Despite increasing awareness about clinical depression, many people still believe a social stigma is associated with emotional problems such as depression or anxiety. As a result, some people may be reluctant to talk about how they are feeling. It is important for your health to seek professional help when feelings of depression or anxiety continue, rather than waiting for these feelings
to get better on their own.

Other emotions you may experience include feeling angry or upset, worried, a loss of control, uncertainty or fear, loneliness, or being a burden to others. Here are some examples of reasons why you may be feeling these emotions:

• Anger or upset: the diagnosis was unexpected and inconvenient
• Loss of control: unable to do usual activities as you were in the past or manage heart failure symptoms
• Uncertainty or fear: not knowing what will happen tomorrow
• Loneliness: no one can understand your illness
• Being a burden to others: dependence on others such as family members, friends, or caregivers to manage your symptoms, diet, exercise, and medications These feelings are common and may go away as you learn more about your condition and ways to manage it.

There are many things you can do to manage your feelings of depression, anxiety, and/or anger. Below are some suggestions to reduce negative feelings, increase positive feelings, build confidence, and ultimately improve your quality of life.

Starting the conversation…

• Talk with a trusted friend, family member, or someone with heart failure. It is powerful to talk about your feelings. The simple act of sharing a problem or worrying out loud may make them more manageable and less overwhelming.Reaching out to family and friends can be comforting and help overcome isolation.
• Join a support group for patients with heart failure or heart disease. Some people find it helpful to discuss their feelings with people who have similar problems. A support group can help you to better cope with your feelings. Ask your doctor where you may find a support group in your community or online.
• Learn more about treatment options for emotional support. Talk to your doctor or nurse if you are struggling and think you might need further help. They can help with finding the right treatment for your needs.

Actively engaging in your health …

• Exercise regularly to reduce feelings of stress, anger, depression, and anxiety. See Module 5: Exercise and Activity for more information.
• Get involved. Try a new activity you might enjoy. Many people with heart failure find that starting a new activity helps keep their mind off their symptoms and provides a new outlook on life. For example, consider volunteering with an organization or agency you care about, participate in heart failure support group activities, or help other patients with heart failure.
• Take an active role in your own health. Increasing your knowledge about self-care will not only improve your heart failure symptoms but help you feel more in control. Learn more about your condition and actively participate in its management. More details about what you can do can be found in:
  • Diet – see Module 2: Low-Sodium Diet
  • Self-Care – see Module 4: Self-Care: Following Your Treatment Plan and Dealing with Your Symptoms
  • Medications – see Module 3: Heart Failure Medicine

Make a list of things you can and cannot do. You can use this list as a guide for talking with your friends and family about your condition and understand how it may impact your life.

Get a good night’s sleep. Research has shown that people who do not feel rested or do not get enough sleep often feel depressed. If you have difficulty sleeping, ask your doctor or nurse about getting good sleep. You might discuss sleep hygiene, medications, or testing for sleep disorders like sleep apnea.

Try to get outside every day even for a few minutes. Getting fresh air can clear your mind and soothe the mood. Make sure to dress appropriately, especially during extremely hot or cold weather.

You can learn more about how to take control of your heart failure by reading the other modules in this series. You can get copies of these modules from your doctor or nurse. Or you can visit the Heart Failure Society of America web site at: www.hfsa.org.

The topics covered in the other modules include:

• Introduction: Taking Control of Heart Failure
• How to Follow a Low-Sodium Diet
• Heart Failure Medicines
• Self-Care: Following Your Treatment Plan and Dealing with Your Symptoms
• Exercise and Activity
• Tips for Family and Friends
• Lifestyle Changes: Managing Other Chronic Conditions
• Advance Care Planning
• Heart Rhythm Problems
• How to Evaluate Claims of New Heart Failure Treatments and Cure