TY - JOUR

T1 - Cognitive-behavioural therapy reduces psychological distress in younger patients with cardiac disease

T2 - a randomized trial

AU - Holdgaard, Annette

AU - Eckhardt-Hansen, Christine

AU - Lassen, Christina Funch

AU - Kjesbu, Ingunn Eklo

AU - Dall, Christian Have

AU - Michaelsen, Kristine Lund

AU - Sibilitz, Kirstine Lærum

AU - Prescott, Eva

AU - Rasmusen, Hanne Kruuse

PY - 2023

Y1 - 2023

N2 - Aims To test whether usual outpatient cardiac rehabilitation (CR) supplemented by a cognitive-behavioural therapy (CBT) intervention may reduce anxiety and depression compared with usual CR. Methods and results In this multicentre randomized controlled trial, 147 cardiac patients (67% men, mean age 54 years, 92% with coronary artery disease) with psychological distress defined as a hospital anxiety and depression scale (HADS) anxiety or depression score >= 8 were randomized to five sessions of group CBT plus usual CR (intervention, n = 74) or CR alone (control, n = 73). Patients with severe distress or a psychiatric diagnosis were excluded. The intervention was delivered by cardiac nurses with CBT training and supervised by a psychologist. A reference, non-randomized group (background, n = 41) of consecutive patients without psychological distress receiving usual CR was included to explore the effect of time on HADS score. The primary outcome, total HADS score after 3 months, improved more in the intervention than in the control group [the mean total HADS score improved by 8.0 (standard deviation 5.6) vs. 4.1 (standard deviation 7.8), P < 0.001]. Significant between-group differences were maintained after 6 months. Compared with the control group, the intervention group also had greater adherence to CR (P = 0.003), more improvement in the heart-related quality of life (HeartQoL) at 6 months (P < 0.01), and a significant reduction in cardiac readmissions at 12 months (P < 0.01). The background group had no significant change in HADS score over time. Conclusion Brief CBT provided by cardiac nurses in relation to CR reduced anxiety and depression scores, improved HeartQoL and adherence to CR, and reduced cardiovascular readmissions. The programme is simple and may be implemented by CR nurses.

AB - Aims To test whether usual outpatient cardiac rehabilitation (CR) supplemented by a cognitive-behavioural therapy (CBT) intervention may reduce anxiety and depression compared with usual CR. Methods and results In this multicentre randomized controlled trial, 147 cardiac patients (67% men, mean age 54 years, 92% with coronary artery disease) with psychological distress defined as a hospital anxiety and depression scale (HADS) anxiety or depression score >= 8 were randomized to five sessions of group CBT plus usual CR (intervention, n = 74) or CR alone (control, n = 73). Patients with severe distress or a psychiatric diagnosis were excluded. The intervention was delivered by cardiac nurses with CBT training and supervised by a psychologist. A reference, non-randomized group (background, n = 41) of consecutive patients without psychological distress receiving usual CR was included to explore the effect of time on HADS score. The primary outcome, total HADS score after 3 months, improved more in the intervention than in the control group [the mean total HADS score improved by 8.0 (standard deviation 5.6) vs. 4.1 (standard deviation 7.8), P < 0.001]. Significant between-group differences were maintained after 6 months. Compared with the control group, the intervention group also had greater adherence to CR (P = 0.003), more improvement in the heart-related quality of life (HeartQoL) at 6 months (P < 0.01), and a significant reduction in cardiac readmissions at 12 months (P < 0.01). The background group had no significant change in HADS score over time. Conclusion Brief CBT provided by cardiac nurses in relation to CR reduced anxiety and depression scores, improved HeartQoL and adherence to CR, and reduced cardiovascular readmissions. The programme is simple and may be implemented by CR nurses.

KW - Coronary artery disease

KW - Cardiac rehabilitation

KW - Anxiety

KW - Depression

KW - Cognitive behavioural therapy

KW - cardiac nursing

KW - CORONARY-HEART-DISEASE

KW - OF-LIFE QUESTIONNAIRE

KW - MYOCARDIAL-INFARCTION

KW - EUROPEAN-SOCIETY

KW - HOSPITAL ANXIETY

KW - POSITION PAPER

KW - RISK-FACTORS

KW - DEPRESSION

KW - REHABILITATION

KW - PREDICTORS

U2 - 10.1093/eurheartj/ehac792

DO - 10.1093/eurheartj/ehac792

M3 - Journal article

C2 - 36649937

VL - 44

SP - 986

EP - 996

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 11

ER -