Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

Abstract

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.

Anxiety and depression in patients with pulmonary hypertension: impact and management challenges

“…Possible approaches based on other chronic illnesses could therefore be suggested. In fact, CBT strategies have been used in cardiovascular diseases, 38 and in COPD. 39 However, there is a paucity of data regarding CBT in the PAH cohort.…”

“…It is recommended to structure all of the psychological activity within the multidisciplinary intervention and in synergy with the team. 38 …”

Psychomotor speed as a predictor of functional status in older chronic heart failure (CHF) patients attending cardiac rehabilitation

“…The 30-point GDS is a questionnaire specifically aimed at assessing depression in old patients, while HADS-A consists of seven specific questions to evaluate anxiety for hospitalized patients. Depressive symptoms were classified as absent for a GDS score 0-10, mild (GDS score [11][12][13][14][15], moderate (GDS score [16][17][18][19][20], or severe (GDS score [21][22][23][24][25][26][27][28][29][30]. Anxiety symptoms were classified as absent (HADS-A score 0-7), mild (HADS-A score 8-10), moderate (HADS-A score [11][12][13][14], or severe (HADS-A score [15][16][17][18][19][20][21].…”

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

“…Modern cardiac rehabilitation programmes also need to integrate a structured intervention on psychosocial risk factors (PSRFs), because of their importance in affecting cardiovascular prognosis, treatment adherence and quality of life. 22,23 At the same time, they should emphasize the importance of return to work and reduce the risk of poor vocational outcomes. 24 Finally, the systematic evaluation of outcome parameters/goals at the end of the programme should now be considered as a real core component of modern cardiac rehabilitation interventions.…”