Depression and cardiovascular disease: mind the gap in the guidelines

Patients with cardiovascular disease (CVD) experience higher rates of depression compared to the general population, complicating disease management, medication adherence, and lifestyle changes. Co-occurring CVD and depression are associated with reduced quality of life, poorer outcomes, and increased mortality. This study aimed to evaluate how CVD clinical practice guidelines (CPGs) address depression, including practical management guidance. A systematic search (2013-2024) identified 65 CPGs published in English, covering general CVD, heart failure, coronary artery disease, peripheral artery disease, stroke, and aortic disease. Seventy-one percent acknowledged depression as a risk factor and 12% referred to a dedicated CPG for comprehensive guidance. Yet only 23% of CPGs provided both screening and treatment recommendations for its management. Twelve percent involved mental health professionals in their development, while 24% focussed on cardiac or stroke rehabilitation, and 9% on women. Stroke CPGs delivered the majority of recommendations (68%), likely due to neurologists' involvement. Cardiac and stroke rehabilitation CPGs delivered 24% of recommendations, whereas women-specific CPGs offered no treatment recommendations. While cognitive-behavioural therapy was the most recommended psychotherapeutic intervention (29% of CPGs), and selective serotonin reuptake inhibitors were the pharmacotherapy most recommended (20% of CPGs), only 3% of CPGs addressed drug-disease interactions associated with treating depression. Depression negatively impacts patients' lives, irrespective of CVD outcomes. CVD CPGs should systematically address depression, consistently involving mental health specialists, to deliver screening and treatment guidance tailored to distinct patient populations for holistic patient care.