A randomized controlled trial of a brief educational and psychological intervention for patients presenting to a cardiac clinic with palpitation

Abstract

Background. We sought to determine whether a brief psycho-educational intervention reduced disability in patients with benign palpitation.Method. In a pragmatic randomized controlled trial within a cardiology clinic at a district general hospital, 80 consecutive patients diagnosed as having benign palpitation – either palpitation due to awareness of extrasystoles or sinus rhythm – with associated distress or disability were randomized to an intervention group (usual care plus nurse-delivered intervention based on cognitive-behavioural principles) or to a control group (usual care). Principal outcome was difference in proportion of participants with good or excellent researcher-rated activity levels at 3 months. Subsidiary outcomes were self-rated symptoms, distress and disability, researcher-rated unmet treatment needs.Results. The principal outcome showed a statistically and clinically significant benefit for the intervention group, with a number needed to treat of 3 (95% CIs 2 to 7). All but one subsidiary outcomes also showed a difference in favour of the intervention group, and several differences reached statistical significance. Significantly more of the control group had unmet treatment needs at 3 months.Conclusions. A brief, nurse-delivered, psycho-educational intervention, was an effective treatment for benign palpitation. Further evaluation, including assessment of cost-effectiveness, is needed. The findings have application to the care of patients presenting with other types of ‘unexplained’ medical symptoms.

Short-term cognitive behavioral therapy for non-cardiac chest pain and benign palpitations: A randomized controlled trial

“…A recent Cochrane review, which evaluated the effectiveness of psychological interventions for noncardiac chest pain based on randomized controlled trials (RCT) [8], reported that cognitive behavioral therapy (CBT) was probably effective in the short term, but there were few studies with long-term follow-up. This is consistent with the only study which has evaluated CBT for patients with benign palpitations [9]. Two studies which have compared patients with noncardiac chest pain and patients with benign palpitations, reported similar psychological characteristics [10,11], and treatment aiming to reduce fear of bodily sensations is supposed to be appropriate for both groups [11].…”

“…Compared with the previous study, where the intervention consisted of 1-3 sessions delivered by a cardiac nurse and a phone call [9], the present study had more obvious effects on health-related quality of life. In addition to confirming similarities of patients with non-cardiac chest pain and patients with benign palpitations, the present study shows that the same treatment manual was useful for both groups.…”

Surviving Bench Stress

“…Consistent exposure to a high stress environment lowers the immune system and creates high vulnerability to disease. 25 Diseases that can be positively impacted by psychological intervention include: cardiac problems, 26 high blood pressure, 27 and gastrointestinal disorders. 28 In the Psychologist Advocate Program, the judges would have the option of requesting a change of psychologist every six months, which builds in a flexibility to accommodate changes in the psychologist's schedule and allows judges to reassess the psychologist-judge team and change to a different psychologist, if necessary.…”

Are Treatments for Common Mental Disorders Also Effective for Functional Symptoms and Disorder?

“…A randomized controlled trial demonstrated the significant benefit of a further appointment with a cardiac nurse, who offered well-specified explanation, discussion, and advice. Also, a 3-month follow-up assessment enabled professionals to identify those patients who required more specialist psychological treatment (25).…”