1
|
Li Z, Liu Y, Wang J, Zhang C, Liu Y. Effectiveness of cognitive behavioral therapy on mood symptoms in patients with implantable cardioverter defibrillator: A systematic review and meta-analysis. Complement Ther Clin Pract 2022; 47:101570. [DOI: 10.1016/j.ctcp.2022.101570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 02/26/2022] [Accepted: 02/26/2022] [Indexed: 11/25/2022]
|
2
|
OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1124-1141. [DOI: 10.1093/eurjpc/zwac006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
|
3
|
Berg SK, Herning M, Schjødt I, Thorup CB, Juul C, Svendsen JH, Jorgensen MB, Risom SS, Christensen SW, Thygesen L, Rasmussen TB. The heart & mind trial: intervention with cognitive-behavioural therapy in patients with cardiac disease and anxiety: randomised controlled trial protocol. BMJ Open 2021; 11:e057085. [PMID: 34862302 PMCID: PMC8647551 DOI: 10.1136/bmjopen-2021-057085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Patients with cardiac disease often experience anxiety (prevalence about 20%-25%) and have a doubled mortality risk when suffering from anxiety compared with patients without anxiety. This calls for interventions aiming to reduce anxiety. METHODS AND ANALYSIS The Heart & Mind Trial consists of three parts: (1) screening of all hospitalised and outpatient cardiac patients with arrhythmia, heart failure or ischaemic heart disease at four university hospitals in Denmark using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A); Patients scoring ≥8 is invited to participate; (2) Assessment of the type of anxiety by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders and (3) Randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive-behavioural therapy (CBT) performed by a CBT-trained cardiac nurse plus usual care or, usual care alone. The primary outcome is anxiety measured with HADS-A at 5 months. Secondary outcomes include anxiety symptoms measured with Becks Anxiety Inventory and heart rate variability. Exploratory outcomes measured at 12 months include blood cortisol (stress response), blood C reactive protein (stress response), health-related quality of life, readmission, mortality and attributable direct costs. A total of 336 patients will be included. The primary analyses are based on the intention-to-treat principle. For the primary outcome, we will use a linear regression model. For the long-term outcomes, mixed regression models will be used including repeated measurements. ETHICS AND DISSEMINATION The trial is performed in accordance with the Declaration of Helsinki. All patients must give informed consent prior to participation and the trial is initiated after approval by the Danish Data Protection Agency (P-2020-894) and the National Committee on Health Research Ethics (H-20066739). Positive, neutral and negative results of the trial will be published. TRIAL REGISTRATION NUMBER NCT04582734.
Collapse
Affiliation(s)
- Selina Kikkenborg Berg
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, 1455, Denmark
| | - Margrethe Herning
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, 2900, Denmark
| | - Inge Schjødt
- Department of Cardiology, Aarhus University Hospital, Aarhus, 8200, Denmark
| | - Charlotte Brun Thorup
- Clinical Nursing Research Unit and Department of Cardiology, Aalborg University Hospital, Aalborg, 9000, Denmark
| | - Carsten Juul
- Psychological consulting, Heypeople, Copenhagen K, 1260, Denmark
| | - Jesper Hastrup Svendsen
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
| | - Martin Balslev Jorgensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
| | - Signe Stelling Risom
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, 2900, Denmark
- University College Copenhagen, Institute of Nursing and Nutrition, Copenhagen N, 2200, Denmark
| | - Signe Westh Christensen
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
| | - Lau Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, 1455, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, 2900, Denmark
| |
Collapse
|
4
|
Christie M, Coyne E, Mitchell M. The educational experiences and needs of patients with an internal cardiac defibrillator: An interpretive phenomenological study. Collegian 2021. [DOI: 10.1016/j.colegn.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
5
|
Schulz SM, Ritter O, Zniva R, Nordbeck P, Wacker C, Jack M, Groschup G, Deneke T, Puppe F, Ertl G, Angermann C, Störk S, Pauli P. Efficacy of a web-based intervention for improving psychosocial well-being in patients with implantable cardioverter-defibrillators: the randomized controlled ICD-FORUM trial. Eur Heart J 2021; 41:1203-1211. [PMID: 30957867 PMCID: PMC9597328 DOI: 10.1093/eurheartj/ehz134] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/28/2018] [Accepted: 02/25/2019] [Indexed: 11/16/2022] Open
Abstract
Aims Anxiety, depression, and reduced quality of life (QoL) are common in patients with implantable cardioverter-defibrillators (ICDs). Treatment options are limited and insufficiently defined. We evaluated the efficacy of a web-based intervention (WBI) vs. usual care (UC) for improving psychosocial well-being in ICD patients with elevated psychosocial distress. Methods and results This multicentre, randomized controlled trial (RCT) enrolled 118 ICD patients with increased anxiety or depression [≥6 points on either subscale of the Hospital Anxiety and Depression Scale (HADS)] or reduced QoL [≤16 points on the Satisfaction with Life Scale (SWLS)] from seven German sites (mean age 58.8 ± 11.3 years, 22% women). The primary outcome was a composite assessing change in heart-focused fear, depression, and mental QoL 6 weeks after randomization to WBI or UC, stratified for age, gender, and indication for ICD placement. Web-based intervention consisted of 6 weeks’ access to a structured interactive web-based programme (group format) including self-help interventions based on cognitive behaviour therapy, a virtual self-help group, and on-demand support from a trained psychologist. Linear mixed-effects models analyses showed that the primary outcome was similar between groups (η
p
2 = 0.001). Web-based intervention was superior to UC in change from pre-intervention to 6 weeks (overprotective support; P = 0.004, η
p
2 = 0.036), pre-intervention to 1 year (depression, P = 0.004, η
p
2 = 0.032; self-management, P = 0.03, η
p
2 = 0.015; overprotective support; P = 0.02, η
p
2 = 0.031), and 6 weeks to 1 year (depression, P = 0.02, η
p
2 = 0.026; anxiety, P = 0.03, η
p
2 = 0.022; mobilization of social support, P = 0.047, η
p
2 = 0.018). Conclusion Although the primary outcome was neutral, this is the first RCT showing that WBI can improve psychosocial well-being in ICD patients. ![]()
Collapse
Affiliation(s)
- Stefan M Schulz
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Marcusstraße 9-11, BY, 97070 Würzburg, Germany.,Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Wallstraße 3, RP, 55122 Mainz, Germany
| | - Oliver Ritter
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Department of Cardiologoephrology and Pulmology, Brandenburg Medical School, University Hospital Brandenburg, Hochstraße 29, BB, 14770 Brandenburg an der Havel, Germany
| | - Richard Zniva
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany
| | - Peter Nordbeck
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, BY, 97080 Würzburg, Germany
| | - Christian Wacker
- Division of Cardiology, Department of Medicine, ANregiomed-Hospital Rothenburg ob der Tauber, Ansbacher Straße 131, BY, 91541 Rothenburg ob der Tauber, Germany
| | - Mary Jack
- Hospital Bad Wörishofen, Tannenbaum 2, BY, 86825 Bad Wörishofen, Germany
| | - Guido Groschup
- Division of Rhythmology, Department of Medicine I, City Hospital Aschaffenburg, Am Hasenkopf 1, BY, 63739 Aschaffenburg, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Centre GmbH, Schlossplatz 1, BY, 97616 Bad Neustadt a. d. Saale, Germany
| | - Frank Puppe
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Chair of Computer Science VI, University of Würzburg, Am Hubland, BY, 97074 Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany
| | - Christiane Angermann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, BY, 97080 Würzburg, Germany
| | - Paul Pauli
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Marcusstraße 9-11, BY, 97070 Würzburg, Germany
| |
Collapse
|
6
|
Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Europace 2021; 23:1336-1337o. [PMID: 33636723 DOI: 10.1093/europace/euaa427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
Collapse
Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | | |
Collapse
|
7
|
Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H, Ambrosetti M, Deneke T, Cornelissen V, R Heinzel F, Davos CH, Kudaiberdieva G, Frederix I, Svendsen JH, Hansen D. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Eur J Prev Cardiol 2021; 28:1736-1752. [PMID: 34038513 DOI: 10.1093/eurjpc/zwaa121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
Collapse
Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | | | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d'Adda, Italy
| | - Thomas Deneke
- Heart Center Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany
| | - Veronique Cornelissen
- Cardiovascular Exercise Physiology Unit, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Frank R Heinzel
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Gulmira Kudaiberdieva
- SRI of Heart Surgery and Organ Transplantation, Center Scientific Research and Development of Education, Bishkek Kyrgyzstan, Adana, Turkey
| | - Ines Frederix
- Hasselt University, Faculty of Medicine & Life Sciences, Hasselt, Belgium.,Antwerp University, Faculty of Medicine & Health Sciences, Antwerp, Belgium.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium.,Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, UHasselt, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| |
Collapse
|
8
|
Carroll AJ, Christon LM, Rodrigue JR, Fava JL, Frisch MB, Serber ER. Implementation, feasibility, and acceptability of quality of life therapy to improve positive emotions among patients with implantable cardioverter defibrillators. J Behav Med 2020; 43:968-978. [PMID: 32285238 PMCID: PMC7554076 DOI: 10.1007/s10865-020-00153-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) save lives, but often induce significant psychological distress among patients. Positive psychological constructs are associated with improved outcomes among cardiac patients. In this NHLBI-funded randomized controlled trial, one aim was to evaluate the feasibility and acceptability of a positive psychology intervention (Quality of Life Therapy; QOLT, n = 11), compared to a Heart Healthy Education (HHE) control (n = 10), among ICD patients. A majority of participants across groups attended all 12 sessions (71%) and completed homework assignments (80%). Agreement on participant engagement and interventionist protocol adherence were high, with no differences between groups (ps > 0.20). A greater proportion of QOLT participants rated their sessions was "very" helpful compared to HHE participants (63% vs. 10%, p = 0.19). These initial data support the feasibility and acceptability of QOLT. A larger-scale trial using positive psychology interventions among ICD patients is indicated to determine potential mechanisms underlying the relationship between positive psychological constructs and cardiovascular health.
Collapse
Affiliation(s)
- Allison J Carroll
- Division of Bio-Behavioral Medicine, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lillian M Christon
- Division of Bio-Behavioral Medicine, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA
| | - James R Rodrigue
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | | | - Eva R Serber
- Division of Bio-Behavioral Medicine, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.
| |
Collapse
|
9
|
Meuret AE, Tunnell N, Roque A. Anxiety Disorders and Medical Comorbidity: Treatment Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:237-261. [PMID: 32002933 DOI: 10.1007/978-981-32-9705-0_15] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).
Collapse
Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Natalie Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Andres Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| |
Collapse
|
10
|
Berg SK, Rasmussen TB, Herning M, Svendsen JH, Christensen AV, Thygesen LC. Cognitive behavioural therapy significantly reduces anxiety in patients with implanted cardioverter defibrillator compared with usual care: Findings from the Screen-ICD randomised controlled trial. Eur J Prev Cardiol 2019; 27:258-268. [PMID: 31575299 DOI: 10.1177/2047487319874147] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to investigate the effect of a cognitive behavioural therapy intervention provided by trained cardiac nurses plus usual care compared with usual care alone in patients with an implanted cardioverter defibrillator who, prior to randomization, had presented with symptoms of anxiety measured by the Hospital Anxiety and Depression Scale. BACKGROUND Around 20-25% of all patients with an implanted cardioverter defibrillator experience anxiety. Among these patients anxiety is associated with mortality, presumably explained by risk behaviour and activation of the autonomic nervous system. We hypothesised that cognitive behavioural therapy provided by cardiac nurses in an out-patient setting would be an effective treatment of anxiety. METHODS This was an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive behavioural therapy plus usual care or to usual care. The primary outcome was Hospital Anxiety and Depression Scale-Anxiety mean score at 16 weeks. Secondary outcomes included Hospital Anxiety and Depression Scale-Depression, Becks Anxiety Inventory, HeartQoL and Hamilton Anxiety Scale. Primary outcome analysis was based on the intention-to-treat principle. RESULTS A total of 88 participants were included, 66% men, mean age 64.3 years and 61% had primary indication implantable cardioverter defibrillator. A significant difference after 16 weeks was found between groups: intervention group (Hospital Anxiety and Depression Scale-A mean (standard deviation) 4.95 points (3.30) versus usual care group 8.98 points (4.03) (p < 0.0001)). Cohen's d was -0.86, indicating a strong clinical effect. The effect was supported by secondary outcomes. CONCLUSION Cognitive behavioural therapy provided by cardiac nurses to patients with a positive screening for anxiety had a statistically and clinically significant effect on anxiety compared with patients not receiving cognitive behavioural therapy.
Collapse
Affiliation(s)
- Selina K Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Denmark.,National Institute of Public Health, University of Southern Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | | | | | - Jesper H Svendsen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Anne V Christensen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| |
Collapse
|
11
|
Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018. Clin Res Cardiol 2019; 108:1175-1196. [DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
|
12
|
Effectiveness of Cognitive Behavioral Therapy for Depression and Anxiety in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis. Psychosom Med 2018; 80:742-753. [PMID: 30281027 DOI: 10.1097/psy.0000000000000626] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Depression and anxiety are highly prevalent in patients with cardiovascular disease (CVD) and influence their mental well-being and CVD prognosis. The primary objective was to assess the effectiveness of cognitive behavioral therapy (CBT) for depression and anxiety in patients with CVD. Secondary objectives were to assess the impact of CBT on cardiovascular mortality, cardiovascular events, patient satisfaction, and quality of life. METHODS MEDLINE, PsycINFO, CINAHL, CENTRAL, and alternative sources were searched for randomized controlled trials and observational studies with a control. Studies were required to assess CBT in coronary heart disease, acute coronary syndrome, atrial fibrillation, or postmyocardial infarction patients, with anxiety and/or depression. Studies were independently screened by two reviewers and critically appraised using the Cochrane Risk of Bias tool. The random-effects model was used to pool standardized mean differences (SMD). RESULTS Twelve randomized controlled trials were included. At follow-up, depression (SMD = -0.35, 95% confidence interval [CI] = -0.52 to -0.17, p < .001, I = 59%) and anxiety (SMD = -0.34, 95% CI = -0.65 to -0.03, p = .03, I = 71%) scores were significantly lower in CBT patients compared with controls. Change in mental health quality of life (SF-12) was also significantly greater for CBT patients, compared with controls (mean difference = 3.62, 95% CI = 0.22 to 7.02, p = .04, I = 0%). No differences in patient satisfaction or cardiovascular events were evident between CBT and control groups. Among the study reports included in this meta-analysis, data specific to cardiovascular mortality were not reported. CONCLUSIONS Cognitive behavioral therapy seems to be an effective treatment for reducing depression and anxiety in patients with CVD and should be considered in standard clinical care.
Collapse
|
13
|
Berg SK, Rasmussen TB, Thrysoee L, Thorup CB, Borregaard B, Christensen AV, Mols RE, Juel K, Ekholm O. Mental health is a risk factor for poor outcomes in cardiac patients: Findings from the national DenHeart survey. J Psychosom Res 2018; 112:66-72. [PMID: 30097138 DOI: 10.1016/j.jpsychores.2018.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To explore (i) the prevalence of cardiac risk factors (obesity, smoking, excessive alcohol consumption and medication non-adherence) among cardiac patients with depression and anxiety, (ii) associations between depression and anxiety scores and cardiac risk factors and (iii) the association of depression and anxiety and cardiac risk factors with mortality, and their population attributable risk. METHODS A national cross-sectional study using patient-reported outcomes at discharge and national register data. For one year (April 15th 2013 to April 15th 2014) all patients discharged or transferred from the five Danish Heart Centres were included in the study. A total of 14,239 patients answered the HADS questionnaire, response rate 51%. RESULTS Mean age was 64.8 years and 69% were male. Patients with depression or anxiety (HADS-D or HADS-A score ≥ 8) had 30% and 45%, respectively, higher odds of being current smokers; 19% and 37% higher odds of being obese and 31% and 24% higher odds of excessive alcohol consumption. Depressive patients had 34% higher odds of being non-adherent to their medication. At one-year follow-up, patients with depression (HADS-D score ≥ 11) had the highest attributable risk associated with mortality followed by: smoking, ischemic heart disease, anxiety, diabetes, hypertension chronic obstructive pulmonary disease and excessive alcohol consumption. CONCLUSION Depression and anxiety in patients with cardiac disease is associated with cardiac risk behaviour such as smoking, obesity, excessive alcohol consumption and medication non-adherence. Depression and anxiety have an attributable risk associated with mortality that is comparable to other well-known risk factors such as smoking.
Collapse
Affiliation(s)
- Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, J.B. Winsløwsvej 4, 5000 Odense C, Denmark.
| | - Charlotte Brun Thorup
- Department of Cardiology, Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløwsvej 4, 5000 Odense C, Denmark.
| | | | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, 8200 Aarhus N, Denmark.
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353 Copenhagen, Denmark.
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353 Copenhagen, Denmark.
| |
Collapse
|
14
|
|
15
|
Berg SK, Rasmussen TB, Mols RE, Thorup CB, Borregaard B, Christensen AV, Cromhout PF, Ekholm O, Juel K, Thrysoee L. Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators: findings from the national DenHeart study. Eur J Cardiovasc Nurs 2018; 18:96-105. [DOI: 10.1177/1474515118794598] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | - Charlotte Brun Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | | | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Denmark
| |
Collapse
|
16
|
Amiaz R, Asher E, Rozen G, Czerniak E, Levi L, Weiser M, Glikson M. Reduction in depressive symptoms in primary prevention ICD scheduled patients - One year prospective study. Gen Hosp Psychiatry 2017; 48:37-41. [PMID: 28917393 DOI: 10.1016/j.genhosppsych.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Implantable Cardioverter Defibrillators (ICDs), have previously been associated with the onset of depression and anxiety. The aim of this one-year prospective study was to evaluate the rate of new onset psychopathological symptoms after elective ICD implantation. METHODS A total of 158 consecutive outpatients who were scheduled for an elective ICD implantation were diagnosed and screened based on the Mini International Neuropsychiatric Interview (MINI). Depression and anxiety were evaluated using the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A). Patient's attitude toward the ICD device was evaluated using a Visual Analog Scale (VAS). RESULTS Patients' mean age was 64±12.4years; 134 (85%) were men, with the majority of patients performing the procedure for reasons of 'primary prevention'. According to the MINI diagnosis at baseline, three (2%) patients suffered from major depressive disorder and ten (6%) from dysthymia. Significant improvement in HAM-D mean scores was found between baseline, three months and one year after implantation (6.50±6.4; 4.10±5.3 and 2.7±4.6, respectively F(2100)=16.42; p<0.001). There was a significantly more positive attitude toward the device over time based on the VAS score [F(2122)=53.31, p<0.001]. CONCLUSIONS ICD implantation significantly contributes to the reduction of depressive symptoms, while the overall mindset toward the ICD device was positive and improved during the one-year follow-up.
Collapse
Affiliation(s)
- Revital Amiaz
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Elad Asher
- Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Rozen
- Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Czerniak
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Levi
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mark Weiser
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Glikson
- Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Berg SK, Herning M, Svendsen JH, Christensen AV, Thygesen LC. The Screen-ICD trial. Screening for anxiety and cognitive therapy intervention for patients with implanted cardioverter defibrillator (ICD): a randomised controlled trial protocol. BMJ Open 2016; 6:e013186. [PMID: 27798030 PMCID: PMC5093681 DOI: 10.1136/bmjopen-2016-013186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Previous research shows that patients with an implanted cardioverter defibrillator (ICD) have a fourfold increased mortality risk when suffering from anxiety compared with ICD patients without anxiety. This research supports the screening of ICD patients for anxiety with the purpose of starting relevant intervention. METHODS AND ANALYSIS Screen-ICD consists of 3 parts: (1) screening of all hospitalised and outpatient patients at two university hospitals using the Hospital Anxiety and Depression Scale (HADS), scores ≥8 are invited to participate. (2) Assessment of type of anxiety by Structured Clinical Interview for DSM Disorders (SCID). (3) Investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive-behavioural therapy (CBT) performed by a cardiac nurse with CBT training, plus usual care or usual care alone. The primary outcome is HADS-A measured at 16 weeks. Secondary outcomes include Becks Anxiety Inventory, HeartQoL, Hamilton Anxiety Scale, heart rate variability, ICD shock, time to first shock and antitachycardia pacing. A total of 88 participants will be included. The primary analyses are based on the intention-to-treat principle and we use a mixed model with repeated measurements for continuous outcomes. For binary outcomes (HADS-A score <8), we use a generalised mixed model with repeated measurements. ETHICS AND DISSEMINATION The trial is performed in accordance with the Declaration of Helsinki. All patients must give informed consent prior to participation and the trial is initiated after approval by the Danish Data Protection Agency (RH-2015-282) and the regional ethics committee (H-16018868). Positive, neutral and negative results of the trial will be published. TRIAL REGISTRATION NUMBER NCT02713360.
Collapse
Affiliation(s)
- Selina Kikkenborg Berg
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Margrethe Herning
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Jesper Hastrup Svendsen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
18
|
Buckley U, Shivkumar K. Stress-induced cardiac arrhythmias: The heart-brain interaction. Trends Cardiovasc Med 2016; 26:78-80. [PMID: 26051207 PMCID: PMC4662914 DOI: 10.1016/j.tcm.2015.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/02/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Una Buckley
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA; UCLA Neurocardiology Research Center of Excellence, David Geffen School of Medicine, Los Angeles, CA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA; UCLA Neurocardiology Research Center of Excellence, David Geffen School of Medicine, Los Angeles, CA.
| |
Collapse
|