title: Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology.
abstract: A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.
authors: Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia.
authors: Nana
authors: N
authors: Pogosova
authors: Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland.
authors: Hugo
authors: H
authors: Saner
authors: Department of Psychology, University of Southern Denmark, Denmark Department of Cardiology, Odense University Hospital, Denmark.
authors: Susanne S
authors: SS
authors: Pedersen
authors: UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University, Belfast, UK.
authors: Margaret E
authors: ME
authors: Cupples
authors: Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland.
authors: Hannah
authors: H
authors: McGee
authors: Medical Psychology, Innsbruck Medical University, Austria.
authors: Stefan
authors: S
authors: Höfer
authors: Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland.
authors: Frank
authors: F
authors: Doyle
authors: Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland.
authors: Jean-Paul
authors: JP
authors: Schmid
authors: Department of Neurology, Bern University Hospital, Switzerland Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland roland.vonkaenel@barmelweid.ch.
authors: Roland
authors: R
authors: von Känel
mesh_terms: D000223:Adaptation, Psychological; D002309:Cardiology / Q000592:standards*; D032921:Consensus; D003299:Cooperative Behavior; D017281:Cost of Illness; D006331:Heart Diseases / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008603:Mental Health; D010348:Patient Care Team / Q000592:standards; D011237:Predictive Value of Tests; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Cardiac rehabilitation; cardiovascular disease; coronary heart disease; psychological stress; risk factors; screening; treatment