Article

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.
CI - (c) The European Society of Cardiology 2014.

Langue : ANGLAIS