Essential Messages and Limitations from the 2025 ESC Clinical Consensus Statement on Mental Health and Cardiovascular Disease

Written by Dr. Veli Sonnur Şenlik

Reference:Bueno H, et al. 2025 ESC Clinical Consensus Statement on mental health and cardiovascular disease: developed under the auspices of the ESC Clinical Practice Guidelines Committee. Eur Heart J. 2025 Aug 29:ehaf191. doi:10.1093/eurheartj/ehaf191

Introduction
Although the association between cardiovascular disease (CVD) and mental health disorders has long been recognized, it remains frequently overlooked in clinical practice. The latest consensus statement from the European Society of Cardiology (ESC) highlights this crucial relationship and urges cardiologists to actively assess and address mental health as an integral part of cardiovascular care.

Essential messages
• To provide holistic and integrated care, the interaction between mental and cardiovascular health must be recognized and addressed.
• Healthcare professionals should aim to develop and implement an integrated “Psycho-Cardio Team” approach tailored to local needs. This team—comprising cardiologists, psychiatrists, psychologists, nurses, and physiotherapists—should deliver a patient-centered and comprehensive model of care that improves both quality of life and long-term outcomes.
• The ACTIVE principles (Acknowledge, Check, Tools, Implement, Venture, Evaluate) provide a practical framework for incorporating mental health into cardiovascular care.
• Screening for mental health conditions (primarily anxiety, depression, and PTSD) and psychosocial risk factors can enhance cardiovascular risk assessment in healthy individuals.
• Mental health screening in patients with CVD is essential, as these conditions are common and associated with poorer outcomes.
• Initial screening can be performed using a brief two-item questionnaire; if concerns arise, longer and validated instruments should follow.
• A stepped-care approach is recommended, with the intensity of psychological care tailored to individual needs.
• There is low-to-moderate evidence supporting psychological interventions for improving depression, anxiety, and quality of life in CVD patients; however, evidence for reducing major adverse cardiac events (MACE) and mortality remains weak or absent.
• Pharmacological treatment (e.g., anxiolytics, antidepressants) should be carefully balanced against risks, considering drug–drug interactions and side effects.
• Caregivers play a key role in patient well-being and adherence but are themselves at risk of mental health challenges; strategies to assess and support caregiver well-being are needed.
• Individuals with severe mental illness experience worse cardiovascular outcomes; ensuring guideline-directed cardiovascular care, adherence, and awareness of significant drug interactions is crucial.
• Special factors (sex, gender, age, frailty, socioeconomic status, comorbidities, concomitant medications) should be evaluated carefully, as they may modify the relationship between mental and cardiovascular health and require personalized approaches.
• Major knowledge gaps persist regarding the complex mechanisms linking mental health and CVD, and optimal strategies to identify, prevent, and manage mental health conditions in CVD patients are lacking.

Limitations

• There is a lack of evidence-based, cost-effective, and personalized interventions aimed at improving psychosocial factors, mental health, and emotional well-being as preventive measures for CVD.
• Optimal screening protocols for mental health conditions in CVD (including timing, frequency, and methods) have not yet been defined or adapted for specific contexts.
• Screening-based treatment algorithms are currently undefined.
• Data on the cost-effectiveness of interventions targeting mental health in CVD populations remain limited.

Limitations Related to Clinical Management

• The feasibility, effectiveness, and sustainability of long-term non-pharmacological interventions—such as physical activity, psychotherapy, and social prescribing—must be established.
• The effectiveness and delivery of specific psychological interventions, including digital health solutions, require further evaluation.
• Effective behavioral strategies must be developed and tested to promote behavioral change and improve cardiovascular risk profiles in individuals with mental illness, including severe mental disorders.
• The role of trauma-focused prevention or therapy for post-traumatic stress disorder (PTSD) related to cardiovascular events remains insufficiently understood.
• Further research is needed on the mental health of caregivers, the prevention of adverse outcomes, and the integration of interventions into routine cardiovascular care.
• Pharmacological studies are required to determine the safety and efficacy of antidepressants and antipsychotics in patients with heart failure and their impact on cardiovascular outcomes.

Limitations in Special Populations

• Cardiovascular risk scores need recalibration for individuals with severe mental illness.
• Randomized controlled trials are needed for interventions in elderly patients with coexisting CVD and mental health disorders.
• More research is required on the effectiveness of multidisciplinary approaches in improving outcomes among individuals with multiple comorbidities.

Limitations in Health Systems and Service Delivery

• Integrated and collaborative care models should be developed and tested for individuals with comorbid cardiovascular and mental health conditions.
• Care pathways facilitating the management of patients with both CVD and mental disorders should be designed and evaluated.
• Community-level and policy interventions addressing socioeconomic inequalities that impact both cardiovascular and mental health are essential.

Commentary:

This guideline clearly demonstrates that the interplay between cardiovascular and mental health has become too significant to ignore. The ESC statement emphasizes that cardiology practice should move beyond purely biological metrics to include the psychosocial dimension as an essential component of patient management. The proposed Psycho-Cardio Team model represents a transformative approach, offering the potential to improve both quality of life and long-term cardiovascular outcomes. However, substantial knowledge gaps remain regarding effective screening methods, intervention strategies, and cost-effectiveness. Future research and healthcare policy should therefore focus on building a holistic, integrated model of care that unites psychological support and cardiovascular treatment as complementary pillars of modern medicine.