Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on 'new' conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings.

- This study is aimed at investigating outpatients' and clients' experience of communication with a group of employees of a hospital in the North of Italy. Participants in the study were 328 patients/users who were asked to report their communicative experience with 20 hospital employees using the Health Care Communication Questionnaire (HCCQ). Employees were 40% administrative, 60% ambulatory nurses and technicians, and 82% females. The comparison between employees on scores obtained showed significant differences in two of the four factors of the questionnaire (Lack of hostility and Non verbal immediacy). Furthermore, the female employees have been perceived by patients as less hostile then men. Female patients/users felt to be more respected then males, but this difference was linked to age, as among males the feeling of being respected decreased with age. Finally, it was possible to observe the scores obtained by each hospital employee in the HCCQ factors, to detect which of the four communicative behaviours has been evaluated by the users as less appropriate. This seems useful for planning personalized training.Key words: communication, patients, hospital personnel.Parole chiave: comunicazione, pazienti, personale ospedaliero