Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep?
Psychological and psychosocial factors have long been linked to cardiovascular disease. These psychosocial factors, including low socioeconomic status, social support/isolation, stress and distress, personality, and sleep disturbance increase risk of cardiovascular events and negatively impact quality of life. These factors may have direct effects on cardiovascular disease via immune or neuroendocrine pathways, or more indirect effects, by, for example, limiting adherence to recommended therapies and cardiac rehabilitation. Most psychosocial risk factors can be assessed relatively easily using standardised tools. Sleep disturbance, in particular, is gaining evidence for its importance and may be crucial to address. While the management of certain psychosocial risk factors is an ethical requirement for care and improves quality of life, unfortunately there is little evidence that such strategies impact on 'hard' endpoints such as recurrent myocardial infarction. A comprehensive biopsychosocial approach to management of these psychosocial factors is required to maximise the benefits patients derive from cardiac care.
Department of Cardiology (Cardiac Rehabilitation), Beaumont Hospital, Beaumont, Dublin 9, Ireland. jonathangallagher@beaumont.ie.
Jonathan
J
Gallagher
Department of General Psychology, University of Padua, Padua, Italy. giulia.parenti@studenti.unipd.it.
Giulia
G
Parenti
Department of Psychology, Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland. FDoyle4@rcsi.ie.
Frank
F
Doyle
D000223:Adaptation, Psychological; D002318:Cardiovascular Diseases / Q000276:immunology / Q000503:physiopathology / Q000523:psychology*; D003863:Depression / Q000276:immunology / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000150:complications / Q000276:immunology / Q000503:physiopathology / Q000523:psychology*; D012934:Social Isolation / Q000523:psychology*; D012944:Social Support; D013315:Stress, Psychological
Cardiac rehabilitation; Cardiovascular disease; Depression/anxiety; Psychological management; Psychosocial risk factors (PSRFs); Sleep