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Gaffey AE, Spatz ES. Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan. Curr Atheroscler Rep 2024; 26:45-58. [PMID: 38240928 PMCID: PMC11219074 DOI: 10.1007/s11883-023-01185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE OF REVIEW Psychological health encompasses a constellation of negative and positive factors-i.e., psychosocial stress, depression, anxiety, trauma, loneliness and social isolation, anger and hostility, optimism, and a sense of purpose. This narrative review presents current evidence at the intersection of psychological health, risk of ischemic heart disease (IHD), and IHD-related outcomes, with an emphasis on associations in women. RECENT FINDINGS For women, relations between psychological health and IHD reflect important sex and gender differences in biological and psychosocial factors. Although efforts devoted to understanding psychological health and IHD risk have varied by psychological factor-scientific evidence is strongest for psychosocial stress and depression, while anxiety, trauma, and positive psychological factors warrant more investigation-less optimal psychological health is consistently associated with an earlier and greater risk of IHD morbidity and mortality in women. Still, many past prospective studies of psychological factors and IHD risk had a limited representation of women, did not include analyses by sex, or failed to account for other influential, sex-specific factors. Thus, there are multiple pathways for further, rigorous investigation into psychological health-IHD associations, mechanisms, and empirically supported psychological interventions to mitigate IHD risk among women. Given the robust evidence linking psychological health with women's risk for IHD, implementing routine, brief, psychological screening is recommended. Significant life events, developmental milestones specific to women, and IHD diagnoses or events could cue further psychological assessment and referral, efforts which will mutually strengthen the evidence for integrated psychological and IHD care and delivery of such care to this vulnerable group.
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Affiliation(s)
- Allison E Gaffey
- Department of Internal Medicine (Section of Cardiovascular Medicine), Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Erica S Spatz
- Department of Internal Medicine (Section of Cardiovascular Medicine), Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
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Borkowski P, Borkowska N. Understanding Mental Health Challenges in Cardiovascular Care. Cureus 2024; 16:e54402. [PMID: 38505437 PMCID: PMC10950038 DOI: 10.7759/cureus.54402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/21/2024] Open
Abstract
There is a profound link between cardiovascular health and mental well-being. This narrative review shows that heart and mental health are not isolated domains but deeply interconnected, influencing each other. It describes how cardiovascular diseases (CVDs) can cause mental health issues such as stress, anxiety, and depression. It also explains how these mental conditions can, in turn, worsen or raise the risk of CVDs. In addition, it emphasizes the necessity of a holistic approach to healthcare that integrates the treatment of physical symptoms of CVDs with interventions aimed at addressing mental health issues. This approach advocates for comprehensive care strategies that include psychotherapy, pharmacological treatments, lifestyle modifications, and digital health technologies. It also highlights the significant role of family and social support in recovery and discusses barriers to integrating mental health care in cardiovascular treatment. The article argues for a paradigm shift in healthcare towards more inclusive and integrated care models. The authors hope to foster a healthcare environment that prioritizes holistic care by increasing awareness about the connection between heart and mind. The call to action includes policy changes and healthcare system reforms aimed at facilitating the integration of mental health services into cardiovascular care, ultimately leading to improved outcomes for patients with CVDs and associated mental health issues.
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Affiliation(s)
- Pawel Borkowski
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
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Shan Y, Chen J, Zhou S, Wen G. Nursing Interventions and Care Strategies for Patients with Coronary Heart Disease: A Comprehensive Review. Galen Med J 2023; 12:1-13. [PMID: 38774841 PMCID: PMC11108677 DOI: 10.31661/gmj.v12i0.2994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular diseases are a major cause of death worldwide, and coronary heart disease (CHD) is a prevalent cardiovascular condition and a significant health burden for the population. In this disease, insufficient blood flow to the heart due to plaque accumulation in the coronary arteries causes chest pain, heart attack, and even death. So, it is vital to identify risk factors, prevention, appropriate treatment, and rehabilitation. Nurses play an indispensable role in managing and caring for patients with CHD. Indeed, they possess a deep understanding of the disease and its complexities, enabling them to provide comprehensive care to patients. Nurses monitor vital signs, administer medications, and perform diagnostic tests, ensuring patients receive timely and appropriate interventions. They also educate patients and their families about CHD, emphasizing lifestyle modifications, medication adherence, and self-care practices. Moreover, nurses offer emotional support, guiding patients through the physical and psychological challenges associated with CHD. Their expertise, compassion, and dedication significantly improve patient outcomes and overall quality of life. Nurses are responsible for assessing, diagnosing, and counseling patients on how to manage their disease, making them the front line of defense in preventing and addressing this serious condition. In the current study, we reviewed the literature to consider the best practices and emerging trends in nursing interventions and care strategies for patients with CHD.
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Affiliation(s)
- Yangyan Shan
- Department of Hemodialysis Room, Funan County Hospital of Traditional Chinese
Medicine, Funan, Anhui 236300, China
| | - Jun Chen
- Department of Hemodialysis Room, Funan County Hospital of Traditional Chinese
Medicine, Funan, Anhui 236300, China
| | - Siwen Zhou
- Department of Hemodialysis Room, Funan County Hospital of Traditional Chinese
Medicine, Funan, Anhui 236300, China
| | - Guangxue Wen
- Department of Nephrology, Funan County Hospital of Traditional Chinese Medicine,
Funan, Anhui 236300, China
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Holdgaard A, Eckhardt-Hansen C, Lassen CF, Kjesbu IE, Dall CH, Michaelsen KL, Sibilitz KL, Prescott E, Rasmusen HK. Cognitive-behavioural therapy reduces psychological distress in younger patients with cardiac disease: a randomized trial. Eur Heart J 2023; 44:986-996. [PMID: 36649937 DOI: 10.1093/eurheartj/ehac792] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/23/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS To test whether usual outpatient cardiac rehabilitation (CR) supplemented by a cognitive-behavioural therapy (CBT) intervention may reduce anxiety and depression compared with usual CR. METHODS AND RESULTS In this multicentre randomized controlled trial, 147 cardiac patients (67% men, mean age 54 years, 92% with coronary artery disease) with psychological distress defined as a hospital anxiety and depression scale (HADS) anxiety or depression score ≥8 were randomized to five sessions of group CBT plus usual CR (intervention, n = 74) or CR alone (control, n = 73). Patients with severe distress or a psychiatric diagnosis were excluded. The intervention was delivered by cardiac nurses with CBT training and supervised by a psychologist. A reference, non-randomized group (background, n = 41) of consecutive patients without psychological distress receiving usual CR was included to explore the effect of time on HADS score. The primary outcome, total HADS score after 3 months, improved more in the intervention than in the control group [the mean total HADS score improved by 8.0 (standard deviation 5.6) vs. 4.1 (standard deviation 7.8), P < 0.001]. Significant between-group differences were maintained after 6 months. Compared with the control group, the intervention group also had greater adherence to CR (P = 0.003), more improvement in the heart-related quality of life (HeartQoL) at 6 months (P < 0.01), and a significant reduction in cardiac readmissions at 12 months (P < 0.01). The background group had no significant change in HADS score over time. CONCLUSION Brief CBT provided by cardiac nurses in relation to CR reduced anxiety and depression scores, improved HeartQoL and adherence to CR, and reduced cardiovascular readmissions. The programme is simple and may be implemented by CR nurses.
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Affiliation(s)
- Annette Holdgaard
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Christine Eckhardt-Hansen
- Department of Social Medicine, Bispebjerg Frederiksberg Hospitals, University of Copenhagen, Denmark
| | - Christina Funch Lassen
- Department of Social Medicine, Bispebjerg Frederiksberg Hospitals, University of Copenhagen, Denmark
| | - Ingunn Eklo Kjesbu
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Christian Have Dall
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Kristine Lund Michaelsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Hanne Kruuse Rasmusen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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Li D, Xu T, Xie D, Wang M, Sun S, Wang M, Zhang S, Yang X, Zhang Z, Wang S, Kuang M, Tang J, Liu H, Hong X, Fu G, Zhang W. Efficacy of mobile-based cognitive behavior therapy on lowering low-density lipoprotein cholesterol level in atherosclerotic cardiovascular disease patients: a multicenter, prospective, randomized controlled tria (Preprint). J Med Internet Res 2022; 25:e44939. [PMID: 37043273 PMCID: PMC10134029 DOI: 10.2196/44939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/15/2023] [Accepted: 03/12/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Elevated low-density lipoprotein cholesterol (LDL-C) is an established risk factor for atherosclerotic cardiovascular disease (ASCVD). However, low adherence to medication and lifestyle management has limited the benefits of lowering lipid levels. Cognitive behavioral therapy (CBT) has been proposed as a promising solution. OBJECTIVE This trial aimed to evaluate the efficacy of mobile-based CBT interventions in lowering LDL-C levels in patients with ASCVD. METHODS This multicenter, prospective, randomized controlled trial enrolled 300 patients with ASCVD, who were randomly assigned to the mobile-based CBT intervention group and the control group in a ratio of 1:1. The intervention group received CBT for ASCVD lifestyle interventions delivered by WeChat MiniApp: "CBT ASCVD." The control group only received routine health education during each follow-up. The linear regression and logistic regression analyses were used to determine the effects of a mobile-based CBT intervention on LDL-C, triglyceride, C-reactive protein, the score of General Self-Efficacy Scale (GSE), quality of life index (QL-index), and LDL-C up-to-standard rate (<1.8 mmol/L) at the first, third, and sixth months. RESULTS Finally, 296 participants completed the 6-month follow-up (CBT group: n=148; control group: n=148). At baseline, the mean LDL-C level was 2.48 (SD 0.90) mmol/L, and the LDL-C up-to-standard rate (<1.8 mmol/L) was 21.3%. Mobile-based CBT intervention significantly increased the reduction of LDL-C change (%) at the 6-month follow-up (β=-10.026, 95% CI -18.111 to -1.940). In addition, this benefit remained when baseline LDL-C <1.8 mmol/L (β=-24.103, 95% CI -43.110 to -5.095). Logistic regression analysis showed that mobile-based CBT intervention moderately increased the LDL-C up-to-standard rates (<1.8 mmol/L) in the sixth month (odds ratio 1.579, 95% CI 0.994-2.508). For GSE and QL-index, mobile-based CBT intervention significantly increased the change of scores (%) at the 1-, 3-, and 6-month follow-up (all P values <.05). CONCLUSIONS In patients with ASCVD, mobile-based CBT is effective in reducing LDL-C levels (even for those who already had a standard LDL-C) and can improve self-efficacy and quality of life. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100046775; https://www.chictr.org.cn/showproj.aspx?proj=127140.
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Affiliation(s)
- DuanBin Li
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Tian Xu
- Ningbo First Hospital, Ningbo, China
| | - DaQi Xie
- Ningbo Ninth Hospital, Ningbo, China
| | - MiaoYun Wang
- Hangzhou Medical College Affiliated Lin An People's Hospital, Hangzhou, China
| | - ShuPing Sun
- Hangzhou Medical College Affiliated Lin An People's Hospital, Hangzhou, China
| | - Min Wang
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | | | - XinRui Yang
- Hangzhou Medical College Affiliated Lin An People's Hospital, Hangzhou, China
| | | | - Shen Wang
- Zhejiang Greentown Cardiovascular Hospital, Hangzhou, China
| | - Ming Kuang
- Hangzhou Kang Ming Information Technology Co., Ltd, Hangzhou, China
| | - Jia Tang
- Hangzhou Kang Ming Information Technology Co., Ltd, Hangzhou, China
| | - HongYing Liu
- Hangzhou Kang Ming Information Technology Co., Ltd, Hangzhou, China
| | - XuLin Hong
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - GuoSheng Fu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - WenBin Zhang
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
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Guo X, Guo X, Wang R, Zhang Y. Effects of Perinatal Cognitive Behavioral Therapy on Delivery Mode, Fetal Outcome, and Postpartum Depression and Anxiety in Women. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8304405. [PMID: 36199781 PMCID: PMC9529422 DOI: 10.1155/2022/8304405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the effects of perinatal cognitive-behavioral therapy on delivery mode, fetal outcome, and postpartum depression and anxiety in women. Methods The clinical data of 88 perinatal pregnant women who came to our hospital from May 2020 to May 2021 were retrospectively analyzed and grouped into the routine group and the cognitive behavioral intervention group according to different perinatal nursing methods, with 44 cases in the cognitive behavioral intervention group received by cognitive behavioral therapy, and 44 cases in the routine group obtained by routine obstetric care during the perinatal period. The anxiety of pregnant women was evaluated by the Hamilton Anxiety Scale (HAMA). The positive cooperation and negative response of the perinatal pregnant women in two groups were recorded. The trial delivery rate, mode of delivery, amount of intrapartum bleeding, neonatal Apgar score, and visual pain simulation score (VAS) within 48 hours after delivery of the pregnant women in the two groups were also recorded and compared. The incidence of depression of pregnant and lying-in women in the two groups was recorded on the 5th and 42nd day after delivery. Results After the intervention, the anxiety score of pregnant women in the cognitive behavioral intervention group was significantly lower than that in the routine group (P < 0.05). Following the intervention, the positive cooperation score of pregnant women in the cognitive behavioral intervention group was prominently higher than that in the routine group, and the negative cooperation score was observably lower than that in the routine group (P < 0.05). The rate of spontaneous delivery in the cognitive behavioral intervention group was significantly higher than that in the conventional group (P < 0.05), while the VAS score and blood loss in the cognitive behavioral intervention group were notably lower than those in the routine group (P < 0.05). The proportion of women with EPDS score <9 points, i.e., no postpartum depression both on the 5th and 42nd day after delivery, were significantly higher than those in the routine group (P < 0.05), whereas the proportion of patients with postpartum depression symptoms scored 9-13 points were markedly lower than those of the routine group (P < 0.05). Conclusion The cognitive behavioral therapy can improve the adverse physiological and psychological reactions of pregnant women with perinatal anxiety disorder, enhance the natural delivery rate and postoperative recovery, reduce the risk of neonatal asphyxia, and ensure the safety of mothers and infants in the perinatal period. Compared with routine nursing, this intervention method is more targeted and scientific, and is worthy of clinical promotion.
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Affiliation(s)
- Xiuqin Guo
- College of Humanities Education, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010059, China
| | - Xiuling Guo
- Obstetrics and Gynecology Department, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010059, China
| | - Ruijun Wang
- Obstetrics and Gynecology Department, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010059, China
| | - Yuan Zhang
- School of Health Management, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
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Kahl KG, Stapel B, Correll CU. Psychological and Psychopharmacological Interventions in Psychocardiology. Front Psychiatry 2022; 13:831359. [PMID: 35370809 PMCID: PMC8966219 DOI: 10.3389/fpsyt.2022.831359] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/18/2022] [Indexed: 01/08/2023] Open
Abstract
Patients with mental disorders have an increased risk to develop cardiovascular disease (CVD), and CVD are frequently comorbid with especially adjustment, anxiety and depressive disorders. Therefore, clinicians need to be aware of effective and safe psychological and pharmacological treatment strategies for patients with comorbid CVD and mental disorders. Cognitive behavioral therapy and third-wave of cognitive-behavioral therapy are effective for patients with CVD and mental disorders. Internet-based psychological treatments may also be considered. In more severe cases, psychopharmacological drugs are frequently used. Although generally well tolerated and efficacious, drug- and dose-dependent side effects require consideration. Among antidepressants, selective serotonin reuptake inhibitors, selective serotonin and noradrenalin reuptake inhibitors, and newer antidepressants, such as mirtazapine, bupropion, agomelatine, and vortioxetine, can be considered, while tricyclic antidepressants should be avoided due to their cardiac side effects. Mood stabilizers have been associated with arrhythmias, and some first- and second-generation antipsychotics can increase QTc and metabolic side effects, although substantial differences exist between drugs. Benzodiazepines are generally safe in patients with CVD when administered short-term, and may mitigate symptoms of acute coronary syndrome. Laboratory and ECG monitoring is always recommended in psychopharmacological drug-treated patients with CVD. Presence of a heart disease should not exclude patients from necessary interventions, but may require careful risk-benefit evaluations. Effectively and safely addressing mental disorders in patients with CVD helps to improve both conditions. Since CVD increase the risk for mental disorders and vice versa, care providers need to screen for these common comorbidities to comprehensively address the patients' needs.
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Affiliation(s)
- Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Christoph U Correll
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
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