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 establishedCHD. 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.affiliation: 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Pogosova
authors.affiliation: 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Saner
authors.affiliation: 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: S S
authors.initials: SS
authors.lastname: Pedersen
authors.affiliation: 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: M E
authors.initials: ME
authors.lastname: Cupples
authors.affiliation: 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Mc Gee
authors.affiliation: 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Hofer
authors.affiliation: 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Doyle
authors.affiliation: 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: J -P
authors.initials: J-
authors.lastname: Schmid
authors.affiliation: 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: VON Kanel On Behalf Of The Cardiac Rehabilitation Section Of The European Association Of Cardiovascular Prevention And Rehabilitation Of The European Society Of Cardiology