Cognitive behavioral therapy plus cardiac rehab reduced patients’ psychological distress
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Cognitive behavioral therapy reduced depression and anxiety and improved heart-related quality of life and adherence among younger patients receiving cardiac rehabilitation, researchers reported.
“It is imperative that psychological interventions for anxiety and depression are developed and integrated into the cardiac rehabilitation setting so that they may be offered to all cardiac patients with psychological distress,” Annette Holdgaard, PhD student nurse in the department of cardiology at Bispebjerg and Frederiksberg Hospital in Copenhagen, Denmark, and colleagues wrote. “This may not only improve patients’ quality of life and clinical outcomes but also has the potential to retain those with limited resources. It is well known that patients with psychological distress tend to be less adherent to cardiac rehabilitation, but it remains unknown if psychological interventions in connection with cardiac rehabilitation may increase adherence.”
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To assess the utility of cognitive behavioral therapy during outpatient cardiac rehabilitation, Holdgaard and colleagues designed a psychoeducational group course of three to four patients that consisted of five sessions conducted by an experienced cardiac nurse as one 2-hour session per week and supervised by a psychologist.
In total, 147 cardiac patients (mean age, 54 years; 67% men; 92% with CAD) with psychological distress defined as a Hospital Anxiety and Depression Scale (HADS) score of 8 or more were randomly assigned to cognitive behavioral therapy on top of cardiac rehabilitation or cardiac rehabilitation alone.
Patients with severe distress or with psychiatric diagnosis were excluded from the study.
The primary outcome was HADS score after 3 months.
The results of the study were published in the European Heart Journal.
The researchers observed greater HADS score improvement in the intervention arm compared with the control arm (mean total improvement in HADS score, 8 vs. 4.1; P < .001), and a significant between-group difference was maintained even after 6 months.
Compared with the control arm, patients who received cognitive behavioral therapy had better adherence to cardiac rehabilitation (P = .003) and improvement in the heart-related quality of life as assessed by the HeartQoL questionnaire at 6 months (P < .01) and significant reduction in cardiac readmissions at 12 months (P < .01), according to the study.
The researchers used a separate nonrandomized group of 41 consecutive patients without psychological distress receiving cardiac rehabilitation to explore the effect of time on HADS score. They observed no significant change in HADS score in this cohort.
“In perspective, cognitive behavioral therapy seems an effective treatment for anxiety and depression in patients with CAD and valvular heart disease,” the researchers wrote. “The brief cognitive behavioral therapy was provided by experienced cardiac nurses at three different centers and with an equal effect at all three centers. The program is simple, feasible, and may be integrated within existing cardiac rehabilitation programs. Whether a similar effect can be achieved in other cardiac patients with psychological distress and whether the effects are maintained are yet to be discovered.”
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