Behavioral Cardiology - Where the Heart and Head Meet

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The need for a patient to consult a cardiologist can be exemplified by the case a 65-year-old man who recently suffered an anterior wall myocardial infarction (MI) and who has been participating in cardiac rehabilitation, who presents with feelings of overwhelming depression and hopelessness. On three occasions since his hospitalization he has been evaluated in the local emergency department (ED) for recurrent chest symptoms. Each time his evaluations have been suggestive of non-cardiac causes for his symptoms and he has been advised to continue with his recommended medications with follow-up through his primary care provider (PCP). After these processes, it is time for the cardiologist to identify and treat the cause of his current distress.

While this case is somewhat extreme and unusual, it is not uncommon. It typifies an unusual dilemma in current cardiovascular (CV) healthcareÔÇöcoronary artery disease (CAD) risk is associated with certain psychosocial factors, such as depression, yet treatments that effectively treat both psychosocial and CAD outcomes have been somewhat elusive. Results of recent clinical research have strengthened the understanding and management of the links between psychosocial and CV health, and have moved the field of behavioral cardiology steadily closer into the mainstream of current clinical cardiology.1,2

Behavioral cardiology is the study and application of psychosocial factors in the assessment and reduction of CAD risk. It is an important field for a number of reasons, including:

  • adverse psychosocial factors are common in persons with CAD,3 with up to 50% of survivors of MI having evidence of significant anxiety and/or depressive disorders;4
  • the presence of adverse psychosocial factors can significantly worsen CAD risk and prognosis;5-12 and
  • psychosocial health status is generally responsive to behavioral and pharmacologic therapies.13,16

Behavioral cardiology is a complex field, as with many areas within behavioral medicine, and is one that hinges largely on the ability of non-behavioralists (generally cardiologists) to identify affected patients and to initiate the early steps in their psychosocial care. CV clinicians are in an important position to identify and help individuals with co-existing CAD and psychosocial distress because they are often among the first to see patients during and after CAD events (MI and coronary artery bypass surgery, etc.)ÔÇöa time when adverse psychosocial factors may become more visible and when patients are often more open to therapeutic recommendations.

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