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. 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.
Conclusions and Future Needs
The evidence linking psychosocial factors to CAD risk is strongÔÇöboth negatively and positively. Some psychosocial treatments have failed to improve CAD outcomes in people at risk for CAD events, but other treatments involving physical activity or SSRI anti-depressant medications show promise for improving psychosocial distress and CAD events in persons who are at risk for both. Population and societal trends will increase the importance of behavioral cardiology in the practice of clinical cardiology and will increase the need for simplified, user-friendly clinical models, which can help apply psychosocial screening and treatment to appropriate patients.Ôûá
A version of this article, with full references, can be found in the Reference Section on the website supporting this business briefing (www.touchcardiology.com).