Heart Health and Mental Well-being — FRAME Intervention
This resource aims to support patients, caregivers, and healthcare providers in improving the awareness, recognition, discussion, and management of mental health among individuals living with a heart condition.
- Foundation — Build your understanding of the connection between heart health and mental well-being.
- Recognition — Learn and identify early signs and risk factors for emotional distress, depression, anxiety and stress.
- Awareness — Understand how heart failure can affect mood, relationships, identity, and quality of life.
- Management — Learn and apply self-management strategies to care for your brain and heart health.
- Engagement — Connect patients and caregivers with community resources and support preventative practices.
of cardiac patients experience anxiety or depression
higher risk of poor outcomes without mental health support
available in French and English
FRAME the discussion: Understanding and addressing the intersection of heart health and mental well-being
This resource aims to support patients, caregivers, and healthcare providers in improving the awareness, recognition, discussion, and management of mental health among individuals living with a heart condition.
In partnership with
Riley’s Story: Managing Your Heart Health and Mental Well-being
Learn more about Riley’s experience understanding the connection between heart health, mental health and finding ways to support your care journey.
*These hypothetical testimonials are composites created using real quotes from individuals living with heart failure in Eastern Ontario, collected between July and November 2024. They are designed to reflect common experiences while protecting individual privacy.
When Riley was first diagnosed with heart failure, it felt like the ground shifted beneath them. Life had already been full of responsibilities, family, and career — but suddenly, everything became uncertain. It wasn’t just about surviving physically; it was about coping emotionally with a diagnosis that would never fully go away.
Emotionally, the uncertainty and stress were a part of it.
Even though Riley was receiving treatment for the physical aspects of heart failure, the emotional side often felt invisible. Conversations with doctors focused mainly on medications, diet, and physical health, but rarely on mental health.
It was through a peer support group that Riley began noticing that their emotional well-being needed just as much attention as their physical health. Finding ways to self-manage and meeting peers were helpful in taking the next steps forward.
Common Myths About Heart Health and Mental Health
MYTH 1“Mental health has nothing to do with your heart.”
Mental health is deeply connected to heart health. Stress, anxiety, and depression can impact physical symptoms, recovery, and overall quality of life.
MYTH 2“You only need to take care of your mental health if you have a mental health condition.”
Everyone can benefit from taking active steps to promote their well-being and improve their mental health. Just like maintaining physical health, proactive mental health care is important for everyone.
MYTH 3“If I don’t feel sad all the time, I must be fine.”
Mental health concerns can show up as fatigue, irritability, sleep problems, or feeling numb — not just sadness. It’s important to notice all emotional changes, not just extreme sadness.
MYTH 4“A mental health condition is a sign of weakness.”
Mental health challenges have nothing to do with being weak or lacking willpower. Recognizing the need to accept help for a mental health condition requires great strength and courage. Anyone can develop a mental health condition.
MYTH 5“It’s obvious when someone has a mental illness.”
Mental health issues is often invisible. Even in new or untreated mental illness, many people are good at hiding their symptoms, because of stigma, self-stigma and discrimination.
(a) Mental Health Commission of Canada (2023). Fact Sheet: Common Mental Health Myths and Misconceptions. https://mentalhealthcommission.ca/resource/fact-sheet-common-mental-health-myths-and-misconceptions/
Heart Failure and Mental Health are Interconnected
What is Heart Failure
Heart failure happens when the heart cannot pump blood as well as it should. This does not mean the heart has stopped working, but it does mean the body may not be getting enough oxygen and nutrients. Symptoms can include shortness of breath, fatigue, swelling, and trouble with daily activities. While heart failure is a long-term condition, with the right treatment and support, many people can manage it and live well.
Why Mental Health Matters
Living with heart failure can affect how you feel emotionally. Many people experience depression, anxiety, or stress. This can impact your overall well-being and daily life. Taking care of your mental health can help you live more fully and happily with heart failure.
Learn more about:
(1) University of Ottawa Heart Institute (2024). Heart Failure: A guide for patients and caregivers.
(2) Rashid, M.A., et al. (2023). Anxiety and Depression in Heart Failure. Current Problems in Cardiology. https://doi.org/10.1016/j.cpcardiol.2023.101987
(3) Henein, M.Y., et al. (2022). Mental Stress on Cardiovascular Health—Part II. Journal of Clinical Medicine. https://doi.org/10.3390/jcm11154405
(4) Veskovic, J., et al. (2023). Depression, anxiety, quality of life, and autonomic nervous system in patients with stable heart failure. BMC Cardiovascular Disorders. https://doi.org/10.1186/s12872-023-03500-8
(5) Carmin, C., et al. (2024). Mental Health Treatment Outcomes in Patients with Heart Failure. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.123.031117
Depression
What is depression?
It is a medical condition where a person feels sad, loses interest in daily activities, withdraws from people, and feels hopeless about the future. Depression is different from grief, sadness related to an event, or low energy.
How can depression affect your heart failure?
Depression can make your heart failure worse. If you are depressed, you will find it harder to exercise, eat well, limit fluids, and take your medicines as directed.
Depression is not caused by a personal weakness.
Sometimes when people feel very depressed and overwhelmed, they may have thoughts of self-harm or feel like giving up. If this happens:
- Go to your nearest emergency room
- Reach out to Talk Suicide Canada at 1-833-456-4566 or text 45645
- A. Consider making a plan to stay safe
What causes depression?
Depression may be caused by one factor or a number of factors. Some factors that might cause depression include:
- An imbalance in the natural chemicals in the brain
- A heart condition
- A chronic health condition such as anemia or hypothyroidism
- Using too much alcohol or drugs
- Family history of depression
- Difficult life events such as:
- Death of a loved one
- Divorce
- Loss of a job
- Childbirth
How do you know if you are depressed?
Ask yourself the following question and answer by choosing the number that most reflects your feelings over the last two weeks.
Over the last two weeks, how much have I been bothered by feeling sad, down, or uninterested in life?
None 9
Severe
Stress
What is stress?
Stress is your body’s reaction to an event or situation (real or imagined). Stress is not so much what happens to you, but how you respond to a situation or event. Too much stress is hard on your mind, body, and especially your heart. While stress is a part of everyday life, too much stress increases a person’s chances of getting or worsening heart disease.
How can stress affect your heart failure?
Chronic stress can increase your heart rate and blood pressure, putting extra strain on your heart. It can increase your blood pressure, cholesterol and increase your risk of heart attack or stroke. It can also make it harder to sleep, eat well, or stick to treatment routines. All of these can worsen heart failure symptoms. Over time, unmanaged stress can lead to inflammation and contribute to the progression of heart disease.
What are stressors?
A stressor is any situation or event that triggers your body’s stress response. Stressors are different for each person.
Examples of stressors:
- Having a new diagnosis of heart failure
- Experiencing chronic pain
- Limits in physical ability
- Dealing with a number of health conditions
- Conflict in a relationship
- Being isolated from friends and family
- Dealing with the death or illness of a loved one
- Changes at work
- Money worries
What might happen if you have too much stress?
How stress can affect your thinking:
- Trouble concentrating, short attention span, easily distracted
- Poor judgment
- Lapse in memory
- Difficulty making simple decisions
- Brooding over problems
- Imagining the worst
- Confusion
How stress can affect your behaviour:
- Crying
- Fidgeting, and pacing
- Having more arguments
- Drinking more coffee, tea, soda
- Withdrawing from others
- Overeating or loss of appetite
- Smoking
- Drinking alcohol
- Sexual difficulties
How stress can affect your body:
- Headache
- Knots in your stomach, feeling sick to your stomach
- Restlessness
- Sweating
- Increased heart rate and blood pressure
- Rapid, shallow breathing
- Muscle tension in jaw, neck, or shoulders
- Tremors in hands or legs
- Tingling or numbness in fingertips
- Trouble sleeping, feeling tired all the time
How stress can affect your emotions:
- Feeling helpless and frustrated
- Feeling overwhelmed by your life
- Feeling anxious, or worried
- Feeling irritable, hostile, or angry
- Feeling down, depressed, or hopeless
How do you know if you are stressed?
Ask yourself the following question (Choose the number that most reflects your feelings over the last two weeks.)
Over the last two weeks, how much have I been bothered by feeling anxious, worried, nervous, or tense?
None 9
Severe
Anxiety
What is anxiety?
Everyone experiences anxiety at times. It is our body’s natural response to a threat (sometimes called the ‘fight-flight-freeze’ response). Our body releases adrenaline in response to a real danger or to something that feels threatening or dangerous. Our heart rate increases and blood shifts to our large muscles.
Normally, anxiety goes away once the threat is gone. Anxiety becomes a problem when a person continues to have worrying thoughts or reacts as if there is a danger even when the situation may not actually be threatening.
How can anxiety affect your heart failure?
The increased heart rate and blood pressure adds stress on your heart. Anxiety needs energy. Anxiety can increase your blood sugar and cholesterol. Both can make your heart failure worse. Anxiety can make it hard to sleep, leaving you feeling more tired.
What causes anxiety?
It is different for every person. Any number of situations can cause you to feel anxious, worried, or tense.
There are things that can make your anxiety response worse:
- Medical conditions such as thyroid problems, heart or lung problems, seizure disorders
- Stopping certain medicines on your own (without your doctor knowing)
- Being dependent on or addicted to alcohol, cocaine, amphetamines, tranquilizers, or heroin
- Always telling yourself the worst will happen
You are more likely to feel anxiety if:
- You have a family history of problems with anxiety
- You have an imbalance of certain chemicals in your brain
What might happen if you have too much anxiety?
Possible body responses:
- Fast, pounding heart
- Rapid breathing, shortness of breath
- Chest pain or discomfort
- Sweating
- Feeling dizzy or lightheaded
- Dry mouth
- Nausea, stomach upset
- Pale (skin can appear lighter due to reduce blood flow)
- Muscle tension
- Trembling, shaking
- Numbness and tingling
- Hot or cold flashes
Possible thoughts:
- Having frightening dreams or thoughts
- Overestimating the chances something bad will happen
- Magnifying how bad the situation is or how bad a future situation will be
- Not believing you can cope
- Having trouble concentrating or making decisions
How anxiety can affect your emotions:
- Changes in alcohol or drug use due to emotional distress
- Needing others to reassure you all the time
- Needing to be with a ‘safe’ person
- Staying away from certain places, activities or people
How do you know if you are anxious?
Ask yourself the following question (Choose the number that most reflects your feelings over the last two weeks.)
Over the last two weeks, how much have I been bothered by feeling anxious, worried, nervous, or tense?
None 9
Severe
Conversational Supports
When you’re living with a heart condition, it’s easy to focus only on physical symptoms. But mental and emotional well-being are just as important — they affect how you feel day to day and your overall quality of life.
If you’re noticing changes in your mood, energy, or stress levels, you’re not alone — and you’re not doing anything wrong. Many people with heart issues experience emotional ups and downs. Talking about it, even in small ways, can help you feel more supported and connected. These conversation-starters are here to make that easier.
How to Talk to Your Healthcare Provider About Mental Health
Your provider is there to support every part of your health — including your emotional wellbeing. These simple phrases can help you begin the conversation:
Notes for my providers
Before your visit, take a moment to reflect: How long have you been feeling this way? Has anything made it better or worse?
Tip: Bringing a few notes can make it easier to start the conversation. You can use this guide, jot things down ahead of time, or even share how you’re feeling through the mood tracker resource if that’s more comfortable.
How to Talk to Your Caregiver, Loved One, Friend, Family Member About Your Mental Health
It can be hard to talk about mental and emotional health, especially with people close to you. These openers can help you share what you’re experiencing in a way that feels right for you:
Notes for myself
Think about what you want to share: How long have you been feeling this way? What kind of support would feel helpful?
Resources to Track Your Well-being
Resources to Track Heart Failure Care — My Heart Failure Diary
My Personal Follow-Up
Download and print the My Heart Failure Diary to track your daily weight, blood pressure, heart rate, tiredness, breathlessness, and how heart failure affects your daily activities.
Use these tools to monitor your mental and physical health over time. Tracking your well-being helps you recognize changes early and gives your healthcare team a clearer picture of how you’re doing between visits.
Self-Assessment Scales
Use the quick self-checks in the Depression, Stress, and Anxiety sections above to rate how you’ve been feeling over the last two weeks. Score yourself on a scale of 0–9 and review the guidance for when to seek help.
Heart Failure Diary
Track your daily symptoms, weight, and medications with this free resource from the Canadian Heart Failure Society. Sharing your diary with your healthcare provider helps them better understand your day-to-day experience.
If you need help right now
Call or text Talk Suicide Canada: 1-833-456-4566 (call) | Text 45645
Go to your nearest emergency room, or call 9-1-1.
Frequently Asked Questions
+ HOW CAN MENTAL HEALTH AFFECT MY HEART FAILURE SYMPTOMS?
Mental health conditions like depression, anxiety, and stress can worsen heart failure symptoms. They may make it harder to follow your care plan, including medication, diet, and activity recommendations. Over time, chronic stress can also impact heart function itself.
+ IS IT NORMAL TO FEEL OVERWHELMED AFTER A HEART FAILURE DIAGNOSIS?
Yes. Many people experience emotional responses such as fear, sadness, irritability, or loss of motivation. These are valid feelings and acknowledging them is the first step toward support and self-care.
→ Find more in the “Understanding the connection” section for early signs and what to watch for.
+ WHAT CAN I DO EACH DAY TO SUPPORT BOTH MY HEART AND MENTAL HEALTH?
Building small daily habits can make a big difference. Examples include short walks, deep breathing, journaling, or routine check-ins with yourself.
+ WHERE CAN I FIND HELP OR SUPPORT FOR STRESS, DEPRESSION, OR ANXIETY?
Help and support is available. You can reach out to your primary care provider, and look for resources, activities and supports in your community.
→ Visit the “Connect to Services” section to search for resources and services.
+ HOW DO I TALK TO MY DOCTOR ABOUT MY MENTAL HEALTH?
It can be hard to start the conversation. You might say, “I’ve been feeling more stressed or down since my diagnosis,” or “I’m finding it hard to cope lately.”
→ Find more tips and conversation starters in the “Conversational Support” section.
+ WHAT SUPPORTS ARE AVAILABLE FOR CAREGIVERS?
Caregivers often carry a lot of emotional weight. This guide includes tools for stress reduction, boundaries, and communication.
→ See the caregiver supports in the “Caregiver Tool” section.
+ WHAT IS THE FRAME INTERVENTION AND HOW DOES IT HELP?
FRAME stands for Foundation, Recognition, Awareness, Management, and Engagement. It’s a resource designed to help you understand the connection between heart failure and mental health, build self-management strategies, and navigate available supports in your local community.