Psychological interventions halve deaths and CV events in heart disease patients

Psychological interventions halve deaths and cardiovascular events in heart disease patients, according to research from Athens, Greece, presented at the Acute Cardiac Care Congress 2013.

13 oct 2013--The Acute Cardiac Care Congress 2013 is the annual meeting of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC). It takes place 12-14 October in Madrid, Spain.

Dr Zoi Aggelopoulou, a nurse and one of the study authors, said: "The nurses on our coronary care unit observed that patients were less likely to have another heart attack, die, or return to hospital when we talked to them about their treatment, played music for them or helped religious patients to say prayers. It made us think that coronary heart disease is not just physical but also has a psychological component."

She added: "We wanted to find out if others had observed the same thing, and whether psychological support had a real impact on the outcomes of patients with coronary heart disease."

The current study was a meta-analysis of 9 randomised controlled trials. The researchers evaluated whether psychological interventions could improve outcomes of patients with coronary heart disease when combined with a conventional rehabilitation programme.

The researchers found that the addition of psychological interventions reduced mortality and cardiovascular events by 55% after 2 years or more.

Dr Aggelopoulou said: "We found a huge benefit of psychological interventions after 2 years, with less patients dying or having a cardiovascular event and therefore fewer repeat hospital visits. The interventions included talking to patients and their families about issues that were worrying them, relaxation exercise, music therapy, and helping them to say prayers."

She added: "Patients want to know what will happen to them when they leave hospital, whether or not they can have sex, and how to take their medication. Our research shows that giving them information and providing reassurance decreases the chances of them dying or having another heart attack. Patients can help instigate this new culture of information by asking more questions and getting more involved in decisions about their treatment."

Population-based studies have shown that psychological factors may have an influence on the likelihood of having a heart attack in the first place. The factors include depression, social isolation, low socioeconomic status, and chronic stress such as occupational or marital distress and stress from caregiving.

Dr Aggelopoulou said: "The results of our study strengthen the evidence that psychological factors have a big role to play in heart disease. Not only do they impact on the risk of having a heart attack, but they also affect the future outlook of a patient who has had a cardiovascular event. This validates our view that cardiovascular disease is not just a physical disease but also has a substantial psychological component."

The researchers concluded that psychological interventions should be incorporated into the rehabilitation of patients with coronary heart disease. Dr Aggelopoulou said: "More clinical trials are needed to clarify which interventions are most effective and how they can best be implemented."

She concluded: "We can help our patients by simply talking to them or introducing new things like music therapy into our clinical practice. Coronary units are busy places – in Greece we sometimes have 1-2 nurses for 10-20 patients in the coronary care unit and we are under time pressure. But our finding that the addition of psychological support on top of physiological therapies reduces death and cardiovascular events by 55% should be a wake-up call that these interventions really do work. Preventing repeat hospital visits would free up the time we need to implement them."

Provided by European Society of Cardiolog

Psychosocial Factors Predict Hypertension and Coronary Heart Disease

October 2, 2007 —- Trait anger in middle-aged men and long-term stress in men and women predicted the progression from prehypertension to hypertension and incident coronary heart disease (CHD); exercise may reduce trait anger, according to the results of the Atherosclerosis Risk in Communities (ARIC) trial reported in the September/October issue of the Annals of Family Medicine.
"Patients with prehypertension are more likely to progress to frank hypertension," write Marty S. Player, MD, from the Medical University of South Carolina in Charleston, and colleagues. "The role of various psychosocial factors in cardiovascular disease has been of interest for many years.... The objective of this study was to investigate whether psychosocial factors are associated with progression from prehypertension to hypertension and to CHD or CHD mortality after adjustments for traditional risk factors."
The investigators performed a secondary analysis of the ARIC cohort of men and women aged 45 to 64 years at enrollment, including 2334 participants who had prehypertension at the second visit conducted between 1990 and 1992, who had no heart disease or stroke at baseline and who were observed from 1996 to 1998 when the ARIC study was completed. The primary endpoints were progression from prehypertension to hypertension and prehypertension to CHD or death from CHD.
Compared with low to moderate levels of trait anger measured by the Spielberger Trait Anger Scale, high levels were associated with progression from prehypertension to hypertension (adjusted odds ratio [OR], 1.53; 95% confidence interval [CI], 1.05 - 2.24). Analysis by sex revealed that trait anger was predictive for men but not for women (OR, 1.71; 95% CI, 1.04 - 2.83), and that trait anger in men was associated with progression to CHD, based on survival analysis (hazard ratio [HR], 1.92; 95% CI, 1.07 - 3.54). In both sexes, long-term psychological stress on the Maastricht Questionnaire was associated with risk for incident CHD(HR, 1.68; 95% CI, 1.18 - 2.40).
"High levels of trait anger in middle-aged prehypertensive men were associated with increased risk of progressing to hypertension and incident CHD," the study authors write. "Long-term stress was also associated with increased risk of incident CHD in both men and women."
Limitations of the study include lack of generalizability to patient populations of different ages, observational design precluding causal inference, low incidence (5.8%) of CHD in women in this cohort, and limited duration of follow-up.
"The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure designated prehypertension as a new blood pressure category based on the increased cardiovascular risks and events associated with blood pressures in this range," the study authors conclude. "The findings of this study further support these associations with prehypertension. Additionally, we were able to show that beyond traditional cardiovascular risk factors, anger and psychological stress play a role in development of CHD in participants with prehypertension."
The Health Resources and Services Administration and the National Heart, Lung, and Blood Institute supported this study. The study authors have disclosed no relevant financial relationships.
Ann Fam Med. 2007;5:403-411.