Brief, intensive group-based cognitive therapy integrated in cardiac rehabilitation reduces psychological distress in cardiac patients with anxiety and depression a randomized controlled

Abstract

Abstract Background/Introduction Patients with coronary artery disease (CAD) and valvular heart disease (VHD) often suffer from psychological distress, which in turn leads to impaired quality of life, delayed return to work, and increased morbidity and mortality. European guidelines emphasize recognition and intervention, but evidence-based treatment options are limited and perceived as costly. Manageable interventions addressing psychological distress in cardiac patients are needed. Purpose To develop an efficient and cost-effective model for cardiac patients to reduce psychological distress. Methods A multi-center randomized clinical trial in patients with newly diagnosed CAD and/or surgically treated VHD, part of the workforce and concomitant psychological distress (defined as Hospital Anxiety and Depression scale (HADS) Anxiety ≥8 or Depression ≥8). The patients were randomized to five sessions of group-based cognitive-behavioral therapy plus cardiac rehabilitation (Intervention, I) or cardiac rehabilitation alone (Control, C). Furthermore, 41 cardiac patients (male gender 85.4%, age 57±6.4 years) without psychological distress (background, B) participated as reference group to follow the natural course. The primary outcome was a total HADS score at three months. Secondary outcomes were return to work, adherence to CR (participation in >80% of planned training sessions), adherence to lifestyle interventions for CVD risk factor goals, HeartQoL (is a disease-specific questionnaire that measures cardiac quality of life), and cardiovascular readmissions after 12 months. Results 148 patients were included, 67% men, mean age 54±7.5 years and median HADS score at baseline 15 (IQR 10–19) (Table 1). At 3 months HADS score improved significantly more in the intervention group (p<0.001) and this difference persisted at 6 months (p<0.001, Figure). Similar results were seen for HADS anxiety and HADS depression (Figure 1). HeartQol also improved more in the intervention group. 78% had returned to work at 6 months in the intervention group versus 67% in the control (p=0.11). There were no differences in other secondary outcomes Conclusion Brief cognitive-behavioral therapy provided by cardiac nurses to patients with CAD/VHD and a high HADS score significantly reduced psychological distress and quality of life. The program is simple and can be integrated with existing CR programs at low costs. Larger trials are needed to confirm the effect of the program on retaining cardiac patients in the workforce. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The trial is fonded by TrygFonden