The study entitled “Impact of a Stress Reduction, Meditation, and Mindfulness Program in Patients with Chronic Heart Failure: A Randomized Controlled Trial” has raised a very important subject to be addressed in patients with heart failure and aimed to do so by conducting a randomized clinical trial. The impact of patients’ stress, depression, lack of life purpose, and psychological changes imposed by a chronic and debilitating disease definitely contributes to worsening quality of life and possibly to worse prognosis.^, To assess this impact and to research possible therapies is deeply needed. The authors should be recognized for their interest and huge effort in conducting such a laborious trial.

The study, however, has some deficiencies. Although the authors claim to be a heart failure with reduced ejection fraction (HFrEF) trial, the study included approximately half of the patients with HFrEF. Despite the heterogeneity of the sample, one-third of patients in the intervention group were lost to follow-up, while no patients were lost in the control group. Therefore, even having screened more than two hundred individuals, only 13 patients were actually submitted to intervention. The authors do not inform us of how these patients were pharmacologically treated, but given that the study was conducted four years ago, one can assume patients’ treatment was outdated.

[…]

A recent study has shown that 1 in 4 cardiologists suffer from emotional disturbances, including stress and other psychiatric disorders. Emotional harassment, discrimination, divorce, and age under 55 years were predisposing factors. The international study included 5931 cardiologists interviewed in 2019, covering all continents. Survey respondents represent only 8% of those invited to participate in the survey. The majority were European, White, married, and with children. Individuals at the beginning of their careers were the most affected. Latin America contributed with 17.7% of responses. Men constituted 77.4% of the sample, and women constituted 22.6%. Therefore, it was a select sample that may not represent the entire spectrum of the population of cardiologists. Emotional disturbances were reported by 28% of respondents. There was considerable regional variation, but South America showed the highest rate of psychological disorders, reaching 39.3%; in Asia, the lowest indexes were observed (20.1%). Women were more prone to these disorders, but they also sought psychological help more frequently. This finding corroborates previous research which observed that suicide is more frequent among women doctors than in the general population.

Other researchers had already documented several emotional disorders among physicians, such as anxiety, depression, suicidal ideation, and suicide. ^– For example, recent research in the United States has documented that 42% of cardiologists suffer from burnout, and 83% have some degree of depression. COVID-19 has greatly accentuated these problems. The phenomenon is universal and seems to affect women in particular. These findings are a cause of concern, because they influence the performance of physicians and, therefore, have a direct impact on medical practice.

[…]