Understanding the diagnostic experience of cardiovascular disease in patients with a pre-existing common mental health condition: a mixed-method study

Background: Anxiety and depression are associated with increased cardiovascular disease (CVD) risk, yet the influence of a pre-existing common mental health condition (CMHC) on the timing and experience of CVD diagnosis remains poorly understood. Methods: A sequential explanatory mixed-methods design was used. UK Biobank data were analysed to identify individuals with anxiety or depression and subsequent diagnosis of CVD. Logistic regression was used to explore the socio-demographic characteristics associated with an increased risk of a CVD diagnosis within 60 days of CMHC diagnosis. Semi-structured interviews with six clinicians and six patients from an East of England cardiology service were analysed to explore diagnostic experiences in this population, using reflexive thematic analysis. Results: Younger age (Odds Ratio (OR)= 0.95, 95% Confidence Interval (CI)= 0.94 -0.97), female sex (ref = male, OR= 0.50, 95% CI 0.42 - 0.59) and white ethnicity (OR= 1.92, 95% CI= 1.14- 3.24) were consistently associated with increased odds of a CVD diagnosis within 60 days of CMHC diagnosis. Qualitative findings indicated that diagnosis operates as a relational sense-making process influenced by mental health considerations, epistemic bias, pathway structures and resource constraints. Clinicians described barriers related to access, inter-professional coordination, and service pressures. Patients highlighted a need for community education, clearer clinical communication, longer consultation time, and improved integration of mental health within cardiology care. Conclusion: CVD diagnostic pathways following CMHC are shaped by patient characteristics, clinician reasoning, and systemic limitations. Embedding psychological services in cardiology, strengthening public education on this topic, and the use of digital innovations for care delivery may support earlier recognition and facilitate shared decision making, promoting more inclusive and individualised treatment.