Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

Pogosova, Nana; Saner, Hugo; Pedersen, Susanne S; Cupples, Margaret E; McGee, Hannah; Höfer, Stefan; Doyle, Frank; Schmid, Jean-Paul; von Känel, Roland (2014). Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. European journal of preventive cardiology, 22(10), pp. 1290-1306. SAGE Publications 10.1177/2047487314543075

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A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Saner, Hugo; Schmid, Jean-Paul and von Känel, Roland

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2047-4873

Publisher:

SAGE Publications

Language:

English

Submitter:

David Herzig

Date Deposited:

23 Jan 2015 16:15

Last Modified:

09 Sep 2017 15:09

Publisher DOI:

10.1177/2047487314543075

PubMed ID:

25059929

Uncontrolled Keywords:

Cardiac rehabilitation, cardiovascular disease, coronary heart disease, psychological stress, risk factors, screening, treatment

BORIS DOI:

10.7892/boris.61876

URI:

https://boris.unibe.ch/id/eprint/61876

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