title: Position paper on the importance of psychosocial factors in cardiology: Update 2013.
abstract: BACKGROUND
  The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008.
  
  
  METHODS
  The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients.
  
  
  RESULTS
  A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted cardioverter defibrillators (ICDs) a subjective health technology assessment is warranted. In particular, the likelihood of affective comorbidities and the onset of psychological crises should be carefully considered.
  
  
  CONCLUSIONS
  The present state of the art paper presents an update of current empirical evidence in psychocardiology. The paper provides evidence-based recommendations for the integration of psychosocial factors into cardiological practice and highlights areas of high priority. The evidence for estimating the efficiency for psychotherapeutic and psychopharmacological interventions has increased substantially since the first release of the policy document but is, however, still weak. There remains an urgent need to establish curricula for physician competence in psychodiagnosis, communication and referral to ensure that current psychocardiac knowledge is translated into the daily routine.
authors.affiliation: Deutsches Forschungszentrum für Gesundheit und Umwelt, Institut für Epidemiologie-2, Helmholtz-Zentrum München, Neuherberg, Germany ; Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum Rechts der Isar der TU München, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ladwig
authors.affiliation: Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Medizinische Fakultät Mannheim, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Lederbogen
authors.affiliation: Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Albus
authors.affiliation: Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Angermann
authors.affiliation: I. Medizinische Klinik für Kardiologie, Angiologie, Pneumologie, Internistische Intensivmedizin und Hämostaseologie, Universitätsmedizin Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.affiliation: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
authors.forename: Denise
authors.initials: D
authors.lastname: Fischer
authors.affiliation: Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Fritzsche
authors.affiliation: Innere Medizin II: Kardiologie, Angiologie und Internistische Intensivmedizin, Theresienkrankenhaus und St. Hedwig-Klinik, Mannheim, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Haass
authors.affiliation: Herz-, Thorax- und Rheumazentrum, Abteilung für Psychokardiologie, Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Jordan
authors.affiliation: Klinik für Allgemeine Innere Medizin und Psychosomatik, Universität Heidelberg, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Jünger
authors.affiliation: Innere Medizin III (Kardiologie/Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kindermann
authors.affiliation: Medizinische Fakultät, Universität des Saarlandes, Blieskastel, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Köllner
authors.affiliation: Fachpraxis für Innere Medizin, Kardiologie, Angiologie und Notfallmedizin, Heidelberg, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kuhn
authors.affiliation: Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.affiliation: Medizinische Klinik 3 (Kardiologie), Helios-Klinikum Wuppertal-Herzzentrum, Universität Witten/Herdecke, Wuppertal, Germany.
authors.forename: Melchior
authors.initials: M
authors.lastname: Seyfarth
authors.affiliation: Fachklinik für Innere Medizin, Abteilung Kardiologie, Klinik am See, Rüdersdorf, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Völler
authors.affiliation: Abteilung Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Waller
authors.affiliation: Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Göttingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
mesh_terms: D002309:Cardiology / Q000592:standards*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D005858:Germany; D006801:Humans; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D011584:Psychology / Q000592:standards*; D011613:Psychotherapy / Q000592:standards*
keywords: anxiety; depression; post-traumatic stress disorder; psychopharmacology; psychotherapy