Depression is more common in people with cardiovascular disease (CVD) than in the general population, and it complicates disease management, medication adherence and lifestyle change [1]. Co-occurring CVD and depression are associated with reduced quality of life, poorer outcomes and increased mortality [1]. A systematic review published in the European Heart Journal in 2025 examined a narrower question: how CVD clinical practice guidelines (CPGs) address depression, including whether they give practical management guidance [1].
What was studied
The authors ran a systematic search covering 2013 to 2024 and identified 65 CPGs published in English [1]. The guidelines spanned general CVD, heart failure, coronary artery disease, peripheral artery disease, stroke and aortic disease [1]. Stroke, as MedlinePlus defines it, is a loss of blood flow to part of the brain that can cause lasting brain damage, long-term disability or death [4]. The unit of analysis was the guideline document, not the patient, so the review describes what guidance says rather than how patients fare [1].
Recognition without instruction
The central finding is a gap between naming depression and giving recommendations for managing it [1].
- 71% of CPGs acknowledged depression as a risk factor [1].
- 12% referred to a dedicated CPG for comprehensive guidance [1].
- 23% provided both screening and treatment recommendations for depression management [1].
Most guidelines recognised depression, but fewer than a quarter gave both screening and treatment recommendations [1].
Who wrote the guidelines, and for whom
The composition of guideline panels and their intended populations varied [1].
- 12% of CPGs involved mental health professionals in their development [1].
- 24% focused on cardiac or stroke rehabilitation [1].
- 9% focused on women [1].
Recommendations were unevenly distributed across disease areas [1]. Stroke CPGs delivered the majority of depression recommendations (68%), which the authors describe as likely due to the involvement of neurologists [1]. Cardiac and stroke rehabilitation CPGs delivered 24% of recommendations, whereas women-specific CPGs offered no treatment recommendations [1].
The question of whether cardiovascular evidence applies equally to women and men has also been examined in a separate trial on a different topic [3]. REBOOT was a randomized trial of beta-blockers after myocardial infarction in patients with left ventricular ejection fraction above 40%, and its pre-specified sex subgroup analysis included 8438 patients, of whom 1627 were women [3]. In women, beta-blocker therapy was associated with a higher rate of the primary composite outcome of death, myocardial infarction or heart failure hospitalization (hazard ratio 1.45, 95% confidence interval 1.04-2.03), with no significant difference in men (P for interaction = .026) [3]. That trial does not concern depression and is included here only as context on sex differences in cardiovascular evidence [3].
Treatment content
Where guidelines named specific treatments, cognitive-behavioural therapy was the most recommended psychotherapeutic intervention, appearing in 29% of CPGs [1]. Selective serotonin reuptake inhibitors (SSRIs) were the pharmacotherapy most recommended, appearing in 20% of CPGs [1]. Only 3% of CPGs addressed drug-disease interactions associated with treating depression [1].
What the authors conclude
The authors state that depression negatively affects patients' lives irrespective of CVD outcomes [1]. They recommend that CVD guidelines systematically address depression, consistently involve mental health specialists, and deliver screening and treatment guidance tailored to distinct patient populations for holistic patient care [1].
Limitations
The design and reporting of this review constrain what it can show [1].
- The search was limited to English-language guidelines published between 2013 and 2024, so guidance in other languages or outside that window is not represented [1].
- The abstract reports what guideline documents contain; it does not report data on clinician adherence or on outcomes for patients treated under more detailed guidelines [1].
- The explanation that neurologists' involvement drove the higher share of stroke recommendations is framed by the authors as likely, not tested [1].
- Some figures describe shares of guidelines and others describe shares of recommendations, and the two denominators should not be compared directly [1].
- Women-specific guidelines made up 9% of the sample, so the absence of treatment recommendations in that group rests on few documents [1].
- The abstract does not state whether guideline quality was appraised or name the issuing bodies, which limits assessment from the abstract alone [1].
- The REBOOT findings come from a subgroup analysis of a single trial on a separate clinical question and do not bear on depression care [3].
References
- Blatch Armon D, Buhayer A, Miteva K, et al. Depression and cardiovascular disease: mind the gap in the guidelines. Eur Heart J. 2025;46(41):4226-4269. doi:10.1093/eurheartj/ehaf479. PMID: 40878995. https://pubmed.ncbi.nlm.nih.gov/40878995/
- Rossello X, Dominguez-Rodriguez A, Latini R, et al. Beta-blockers after myocardial infarction: effects according to sex in the REBOOT trial. Eur Heart J. 2026;47(6):701-715. doi:10.1093/eurheartj/ehaf673. PMID: 40884211. https://pubmed.ncbi.nlm.nih.gov/40884211/
- MedlinePlus, National Library of Medicine. Stroke | CVA | Cerebrovascular Accident | MedlinePlus. Accessed October 13, 2026. https://medlineplus.gov/stroke.html