Anxiety and depression in cardiac amyloidosis: a systematic review

Objectives: Cardiac amyloidosis (CA) is a rare and underdiagnosed disease associated with a high mortality rate. Although, in the last decade, there has been increasing attention in the literature to the relationship between CA and psychological distress in patients, the evidence on this association has not yet been systematised. Therefore, this study aims to fill this gap. Design: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted. Data sources: PubMed, ScienceDirect, Scopus and Web of Science were searched, with the last update conducted on 23 September 2024, and no time restrictions were applied. Eligibility criteria: Studies had to meet the following inclusion criteria to be included: (1) original quantitative research; (2) published in peer-reviewed journals written in English; (3) explore and report the relationship between CA and psychological distress or compare a clinical group with a control group and (4) investigate psychological distress through reliable and validated measures. Data extraction and synthesis: One author extracted the data, which was then double-checked by another, and data were reported both in tabular and textual form. The included studies were critically evaluated using the Appraisal Tool for Cross-Sectional Studies. Results: Through the research process, a total of 14 articles were selected. The quality assessment scores ranged from 12 to 18 (M=16.21±1.42). Overall, the results underline a significant presence of psychological distress in patients with CA. Moreover, while disease severity was not found to be associated with psychological distress in CA patients in all studies considered, more heterogeneous results emerged regarding the association between the severity of cardiac symptoms and psychological distress. Conclusions: Results suggest that psychological distress is an important aspect to be considered when dealing with CA patients. Integrating psychological assessment and support may improve patient outcomes by reducing disease burden and enhancing treatment adherence. Prospero registration number: CRD42023446913.