Behavioral Cardiology - Where the Heart and Head Meet

Login or register to view PDF.

Pages

As of yet, interventional studies are scarce that have explored interventions to increase optimism, sense of humor and other positive emotions,41,42 but, on the other hand, physical activity interventions have demonstrated improvements in mood and sense of wellbeing.43 In addition, effective and feasible methods to help patients increase their adherence to preventive therapies have been identified and validated.1,44-46 If such interventions can help improve therapies of known effectiveness, such as lipid lowering therapy and anti-hypertensive therapyÔÇötwo areas of treatment that are vastly under-prescribed by healthcare providers and under-utilized by patientsÔÇö then they could substantially help reduce rates of CAD events in the future.

Putting Behavioral Cardiology into Clinical Cardiology Practice

Despite limitations to current knowledge about which psychosocial interventions reduce CAD risk the most, it is clear that the time for behavioral cardiology in current clinical cardiology has arrived.1,2 The impact of psychosocial factors on treatment adherence alone warrants an increased focus on behavioral cardiology by CV clinicians. The application of these principles will become increasingly important as quality of care indicators and outcome report cards become a standard part of clinical cardiology.

Population and societal trends foreshadow a growing population of individuals with chronic CAD and increasing expectations that clinicians will provide appropriate psychosocial care for their patients at risk for CAD events. To overcome patient, provider, and systematic barriers and to successfully implement effective screening and treatment methods, further research in behavioral cardiology barriers and implementation is needed. There is also an immediate need to provide clinicians with screening and treatment guidelines and tools that are simple, effective, and user-friendly. Based on current levels of knowledge, several components emerge that can help busy clinicians integrate pertinent behavioral cardiology principles into a clinical practice. These include:

  • building group consensus around the need for improving behavioral cardiology components in practices;
  • identifying key psychosocial factors to be screened, and the screening tools to be used;
  • incorporating screening and treatment guidelines into practices, using streamlined processes, effective communications and reminder tools, and appropriately trained clinical staff;
  • applying guidelines and assess adherence to them by clinical staff;
  • providing feedback to clinicians regarding their adherence to guidelines;
  • following-up with patients and assessing their clinical outcomes, satisfaction with their care, and adherence to recommended therapies; and
  • updating practice guidelines regularly based on feedback from clinicians and patients.

 

Pages

References
  1. Rozanski A, Blumenthal J A, Davidson K W, Saab P G, Kubzansky L, The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology, J. Am. Coll. Cardiol. (2005);45(5): pp. 637-651.
    Crossref | PubMed
  2. Pickering T, Clemow L, Davidson K, Gerin W, Behavioral cardiologyÔÇöhas its time finally arrived?, Mt Sinai J. Med. (2003);70: pp. 101-112.
    PubMed
  3. Bankier B, Januzzi J L, Littman A B, The high prevalence of multiple psychiatric disorders in stable outpatients with coronary heart disease, Psychosom. Med. (2004);66: pp. 645-650.
    Crossref | PubMed
  4. Lane D, Carroll D, Ring C, Beevers D G, Lip G Y, The prevalence and persistence of depression and anxiety following myocardial infarction, Br. J. Health Psychol. (2002);7(pt 1): pp. 11-21.
    Crossref | PubMed
  5. Strike P C, Steptoe A, Psychosocial factors in the development of coronary artery disease, Progress. Cardiovasc. Dis. (2004);46: pp. 337-347.
    Crossref | PubMed
  6. Frasure-Smith N, Lesperance F, Reflections on depression as a cardiac risk factor, Psychosom. Med. (2005);67 suppl. 1: pp. S19-S25.
    Crossref | PubMed
  7. Ramachandruni S, Handberg E, Sheps D S,Acute and chronic psychological stress in coronary disease, Curr. Opin Cardiol. (2004);19: pp. 494-499.
    Crossref | PubMed
  8. Haynes S G, Feinleib M, Kannel W B, The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart disease, Am. J. Epidemiol. (1980);111: pp. 37-58.
    Crossref | PubMed
  9. Rutledge T, Reis S E, Olson M et al., National Heart, Lung, and Blood Institute, Social networks are associated with lower mortality rates among women with suspected coronary disease: the National Heart, Lung, and Blood Institute-Sponsored Women's Ischemia Syndrome Evaluation study, Psychosom Med. (2004);66: pp. 882-888.
    Crossref | PubMed
  10. Rowan P J, Haas D, Campbell J A, Maclean D R, Davidson K W,Depressive symptoms have an independent, gradient risk for coronary heart disease incidence in a random, population-based sample, Ann. Epidemiol. (2005);15: pp. 316-320.
    Crossref | PubMed
  11. Todaro J F, Shen B J, Niaura R, Spiro A 3rd,Ward K D,Effect of negative emotions on frequency of coronary heart disease (The Normative Aging Study), Am. J. Cardiol. (2003);92: pp. 901-906.
    Crossref | PubMed
  12. Everson-Rose S A, Lewis T T, Psychosocial factors and cardiovascular diseases, Annu. Rev. Public Health. (2005);26: pp. 469-500.
    Crossref | PubMed
  13. Sebregts E H, Falger P R, Appels A, Kester A D, Bar F W, Psychological effects of a short behavior modification program in patients with acute myocardial infarction or coronary artery bypass grafting. A randomized controlled trial, J. Psychosom. Res. (2005);58: pp. 417-424.
    Crossref | PubMed
  14. Lett H S, Davidson J, Blumenthal J A, Nonpharmacologic treatments for depression in patients with coronary heart disease, Psychosom. Med. (2005);67 suppl. 1:S58-S62.
    Crossref | PubMed
  15. Roose S P, Miyazaki M,Pharmacologic treatment of depression in patients with heart disease, Psychosom. Med. (2005);67 suppl. 1:S54-S57.
    Crossref | PubMed
  16. Lavie C J, Milani R V, Prevalence of hostility in young coronary artery disease patients and effects of cardiac rehabilitation and exercise training,Mayo Clin. Proc. (March 2005);80: pp. 335-342.
    Crossref | PubMed
  17. Emberson J R,Whincup P H, Morris R W,Walker M, Re-assessing the contribution of serum total cholesterol, blood pressure and cigarette smoking to the aetiology of coronary heart disease: impact of regression dilution bias, Eur. Heart J. (2003);24: pp. 1,719-1,726.
    Crossref | PubMed
  18. Daviglus M L, Stamler J, Pirzada A et al., Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality, JAMA (October 6 2004);292(13): pp. 1,588-1,592.
    Crossref | PubMed
  19. Lloyd-Jones D M, Wilson P W, Larson M G et al., Framingham risk score and prediction of lifetime risk for coronary heart disease, Am. J. Cardiol. (July 1 2004);94(1): pp. 20-24.
    Crossref | PubMed
  20. Rugulies R, Depression as a predictor for coronary heart disease.A review and meta-analysis, Am. J. Prev. Med. (2002);23: pp. 51-61.
    Crossref | PubMed
  21. van Melle J P, de Jonge P, Spijkerman T A et al.,Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis, Psychosom. Med. (2004);66: pp. 814-822.
    Crossref | PubMed
  22. Bruce E C, Musselman D L, Depression, alterations in platelet function, and ischemic heart disease, Psychosom. Med. (2005);67 suppl. 1:S34-36.
    Crossref | PubMed
  23. Carney R M, Freedland K E,Veith R C,Depression, the autonomic nervous system, and coronary heart disease, Psychosom. Med. (2005);67 suppl. 1:S29-S33.
    Crossref | PubMed
  24. Carney R M, Blumenthal J A, Freedland K E et al.,Low heart rate variability and the effect of depression on post-myocardial infarction mortality, Arch. Intern. Med. (2005);165: pp. 1,486-1,491.
    Crossref | PubMed
  25. Lawler K A,Younger J W, Piferi R L et al.,A change of heart: cardiovascular correlates of forgiveness in response to interpersonal conflict, J. Behav. Med. (2003);26: pp. 373-393.
    Crossref | PubMed
  26. Gerin W, Pieper C, Levy R, Pickering T G, Social support in social interaction: a moderator of cardiovascular reactivity, Psychosom. Med. (1992);54: pp. 324-336.
    Crossref | PubMed
  27. Kubzansky L D, Sparrow D,Vokonas P, Kawachi I, Is the glass half empty or half full? A prospective study of optimism and coronary heart disease in the normative aging study, Psychosom. Med. (2001);63: pp. 910-916.
    Crossref | PubMed
  28. Rozanski A, Kubzansky L D, Psychologic functioning and physical health: a paradigm of flexibility, Psychosom. Med. (2005);67 suppl. 1:S47-S53.
    Crossref | PubMed
  29. O'Keefe J H Jr, Poston W S, Haddock C K, Moe R M, Harris W,Psychosocial stress and cardiovascular disease: how to heal a broken heart, Comp.Ther. (2004);30: pp. 37-43.
    Crossref | PubMed
  30. Clark A, Seidler A, Miller M, Inverse association between sense of humor and coronary heart disease, Int. J. Cardiol. (2001);80: pp. 87-88.
    Crossref | PubMed
  31. Fredrickson B L, Levenson R W,Positive emotions speed recovery from the cardiovascular sequelae of negative emotions, Cogn. Emotion (1998);12: pp. 191-220.
    Crossref | PubMed
  32. Cohen S, Doyle W J,Turner R B,Alper C M, Skoner D P,Emotional style and susceptibility to the common cold, Psychosom. Med. (2003);65: pp. 652-657.
    Crossref | PubMed
  33. Peyrot M, McMurry J F Jr, Kruger D F, A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence, J. Health Soc. Behav. (1999);40(2): pp. 141-158.
    Crossref | PubMed
  34. Ziegelstein R C, Kim S Y, Kao D et al., Can doctors and nurses recognize depression in patients hospitalized with an acute myocardial infarction in the absence of formal screening?, Psychosom. Med. (2005);67: pp. 393-397.
    Crossref | PubMed
  35. Blumenthal J A, Babyak M A, Carney R M et al., Exercise, depression, and mortality after myocardial infarction in the ENRICHD trial, Med. Sci. Sports Exerc. (2004);36: pp. 746-755.
    Crossref | PubMed
  36. Berkman L F, Blumenthal J, Burg M et al., Enhancing Recovery in Coronary Heart Disease Patients Investigators (ENRICHD). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial, JAMA (2003);289: pp. 3,106-3,116.
    Crossref | PubMed
  37. Glassman A H, O'Connor C M, Califf R M et al., Sertraline Antidepressant Heart Attack Randomized Trial (SADHART) Group. Sertraline treatment of major depression in patients with acute MI or unstable angina, JAMA (2002);288: pp. 701-719.
    Crossref | PubMed
  38. Taylor C B,Youngblood M E, Catellier D et al.,ENRICHD Investigators. Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction, Arch. Gen. Psychiatry (2005);62: pp. 792-798.
    Crossref | PubMed
  39. Blumenthal J A,Wei J, Babyak M et al., Stress management and exercise training in cardiac patients with myocardial ischemia: effects on prognosis and on makers of myocardial ischemia, Arch. Intern. Med. (1997);157: pp. 2,213-2,223.
    Crossref | PubMed
  40. Blumenthal J A, Babyak M,Wei J et al., Usefulness of psychosocial treatment of mental stress-induced myocardial ischemia in men, Am. J. Cardiol. (2002);89: pp. 164-168.
    Crossref | PubMed
  41. Janz N K, Dodge J A, Janevic M R et al., Understanding and reducing stress and psychological distress in older women with heart disease, J.Women Aging (2004);16: pp. 19-38.
    Crossref | PubMed
  42. Bennett M P, Zeller J M, Rosenberg L, McCann J, The effect of mirthful laughter on stress and natural killer cell activity, Altern.Ther. Health Med. (2003);9: pp. 38-45.
    PubMed
  43. Netz Y,Wu M J, Becker B J,Tenenbaum G, Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies, Psychol.Aging (2005);20: pp. 272-284.
    Crossref | PubMed
  44. Haskell W L, Cardiovascular disease prevention and lifestyle interventions. Effectiveness and efficacy, J. Cardiovasc. Nurs. (2003);18: pp. 245-255.
    Crossref | PubMed
  45. Glasgow R E, Goldstein M G, Ockene J K, Pronk N P, Translating what we have learned into practice. Principles and hypotheses for interventions addressing multiple behaviors in primary care, Am. J. Prev. Med. (2004);27(suppl. 2): pp. 88-101.
    Crossref | PubMed
  46. DeBusk R F, Miller N H, Superko H R et al., A case-management system for coronary risk factor modification after acute myocardial infarction, Ann. Intern. Med. (1994);120: pp. 721-729.
    Crossref | PubMed