Heart failure and mental health: assessment of Moroccan cardiologists practices and perceptions
S Driouach, A Outahayou, K Zrigui, D El Hmaidi, N MouineAbstract
Background
Mental health disorders are highly prevalent in patients with heart failure and significantly affect clinical outcomes. The 2025 ESC Clinical Consensus Statement emphasizes mental health assessment as an essential component of cardiovascular care. However, awareness and implementation in low- and middle-income settings remain insufficiently documented, and the situation in Morocco is largely unknown.
Purpose
This study aimed to assess Moroccan cardiologists’ awareness and practices regarding identification and management of mental health disorders in heart failure patients, and to explore potential strategies to improve care.
Methods
An independent, nationwide, cross-sectional web-based survey was conducted among cardiologists in Morocco to assess mental health in patients with heart failure. An anonymous 22-item questionnaire collected information on demographics, perceived impact of mental health disorders, screening and management practices, and barriers to care.
Results
326 cardiologists completed the survey, covering 10 of the 12 Moroccan regions; 24% specialized in heart failure, and most worked in public healthcare settings, including university hospitals and peripheral centers. Regarding prevalence, 46% estimated that mental health disorders affect 10–25% of heart failure patients, while 29% estimated a prevalence of 25–50%. Overall, 62% reported that mental health issues often or moderately affect treatment adherence, and 41% believed they may increase the risk of rehospitalization. Routine screening was infrequent: 6% reported always screening, 17% often, 55% sometimes, and 22% never. Among those who screened, 89% did not use ESC-recommended tools. Major perceived barriers to mental health integration included limited consultation time (80%), insufficient mental health resources (50%), lack of cardiologist training or experience (45%), and absence of coordinated cardio-psychiatry pathways (40%). Access to psychiatrists or psychologists was considered limited or moderately accessible by 79% of respondents. Finally, 86% expressed interest in initiatives aimed at integrating mental health into heart failure care.
Conclusion
Mental health disorders are common in heart failure patients in Morocco. Although cardiologists recognize their importance, systematic screening and management remain limited, highlighting the need for standardized protocols, better access to specialists, and integrated cardio-psychiatry care.Central IllustrationFor image description, please refer to the figure legend and surrounding text.