Christian Albus1, Christiane Waller2, Kurt Fritzsche3, Hilka Gunold4, Markus Haass5, Bettina Hamann6, Ingrid Kindermann7, Volker Köllner8, Boris Leithäuser9, Nikolaus Marx10,11, Malte Meesmann12, Matthias Michal13, Joram Ronel14, Martin Scherer15, Volker Schrader16, Bernhard Schwaab17, Cora Stefanie Weber18, Christoph Herrmann-Lingen19. 1. Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany. christian.albus@uk-koeln.de. 2. Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany. 3. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany. 4. Department of Cardiology, University Medical Center Leipzig, Leipzig, Germany. 5. Department of Cardiology, Angiology and Intensive Care, Theresienkrankenhaus, Mannheim, Germany. 6. Department of Psychocardiology, Kerckhoff-Klinik, Bad Nauheim, Germany. 7. Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Homburg/Saar, Germany. 8. Department of Psychosomatics and Behavioural Medicine, Seehof Rehabilitation Center, Teltow, Germany. 9. Preventive Care Center, Cardiovascular Practice, Hamburg, Germany. 10. Department of Internal Medicine I, Cardiology, Angiology and Intensive Care, University Hospital Aachen, Aachen, Germany. 11. For the Committee on Clinical Cardiovascular Medicine of the German Cardiac Society, Düsseldorf, Germany. 12. Department of Cardiology, Juliusspital, Würzburg, Germany. 13. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany. 14. Department of Psychosomatic Medicine and Psychotherapy, Clinic Barmelweid, Erlinsbach, Switzerland. 15. Institute and Clinic of General Practice and Primary Care, Medical Center Hamburg-Eppendorf, Hamburg, Germany. 16. Cardiopulmonary Practice, Nuremberg, Germany. 17. Curschmann Klinik, Timmendorfer Strand, Germany. 18. Department of Psychosomatic Medicine and Psychotherapy, Hennigsdorf Hospital, Hennigsdorf, Germany. 19. Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre and German Centre for Cardiovascular Research (DZHK), partner site, Göttingen, Germany.
Abstract
BACKGROUND: Psychosocial factors in cardiovascular diseases are increasingly acknowledged by patients, health care providers and payer organizations. Due to the rapidly increasing body of evidence, the German Cardiac Society has commissioned an update of its 2013 position paper on this topic. The German version was published in 2018 and the current manuscript is an extended translation of the original version. METHODS: This position paper provides a synopsis of the state of knowledge regarding psychosocial factors in the most relevant cardiovascular diseases and gives recommendations with respect to their consideration in clinical practice. RESULTS: Psychosocial factors such as low socioeconomic status, acute and chronic stress, depression, anxiety and low social support are associated with an unfavorable prognosis. Psychosocial problems and mental comorbidities should be assessed routinely to initiate targeted diagnostics and treatment. For all patients, treatment should consider age and gender differences as well as individual patient preferences. Multimodal treatment concepts should comprise education, physical exercise, motivational counseling and relaxation training or stress management. In cases of mental comorbidities, brief psychosocial interventions by primary care providers or cardiologists, regular psychotherapy and/or medications should be offered. While these interventions have positive effects on psychological symptoms, robust evidence for possible effects on cardiac outcomes is still lacking. CONCLUSIONS: For coronary heart disease, chronic heart failure, arterial hypertension, and some arrhythmias, there is robust evidence supporting the relevance of psychosocial factors, pointing to a need for considering them in cardiological care. However, there are still shortcomings in implementing psychosocial treatment, and prognostic effects of psychotherapy and psychotropic drugs remain uncertain. There is a need for enhanced provider education and more treatment trials.
BACKGROUND:Psychosocial factors in cardiovascular diseases are increasingly acknowledged by patients, health care providers and payer organizations. Due to the rapidly increasing body of evidence, the German Cardiac Society has commissioned an update of its 2013 position paper on this topic. The German version was published in 2018 and the current manuscript is an extended translation of the original version. METHODS: This position paper provides a synopsis of the state of knowledge regarding psychosocial factors in the most relevant cardiovascular diseases and gives recommendations with respect to their consideration in clinical practice. RESULTS:Psychosocial factors such as low socioeconomic status, acute and chronic stress, depression, anxiety and low social support are associated with an unfavorable prognosis. Psychosocial problems and mental comorbidities should be assessed routinely to initiate targeted diagnostics and treatment. For all patients, treatment should consider age and gender differences as well as individual patient preferences. Multimodal treatment concepts should comprise education, physical exercise, motivational counseling and relaxation training or stress management. In cases of mental comorbidities, brief psychosocial interventions by primary care providers or cardiologists, regular psychotherapy and/or medications should be offered. While these interventions have positive effects on psychological symptoms, robust evidence for possible effects on cardiac outcomes is still lacking. CONCLUSIONS: For coronary heart disease, chronic heart failure, arterial hypertension, and some arrhythmias, there is robust evidence supporting the relevance of psychosocial factors, pointing to a need for considering them in cardiological care. However, there are still shortcomings in implementing psychosocial treatment, and prognostic effects of psychotherapy and psychotropic drugs remain uncertain. There is a need for enhanced provider education and more treatment trials.
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