CHAPTER 35 Psychological Factors and Heart Disease
Patients diagnosed with heart disease often experience emotional distress due to the life-threatening nature of their disease and are faced with functional impairments that may influence quality of life. In turn, these psychological manifestations interfere with adherence to treatment and increase the risk for mortality and morbidity. The risk incurred by psychological factors is of equal magnitude to that of standard risk factors, including somatic indicators of disease severity, such as left ventricular dysfunction.This chapter focuses on the psychological impact of heart disease and consequences of psychological manifestations for prognosis, with emphasis on depression, anxiety, social isolation, health status, and Type D personality. Mechanisms, both biological and behavioural, that may be responsible for the link between psychological factors and cardiac prognosis are discussed. Results of recent behavioural and pharmacological intervention trials targeting psychological factors are also presented.
In order to enhance secondary prevention in patients with established heart disease, patients should be screened for psychological risk factors in clinical practice. When seeing patients, it is important that cardiologists take the time to listen carefully to patients, use clear and succinct communication, and make specific and simple recommendations. Time should also be allocated to follow-up patient adherence with medication and lifestyle changes. Patients with psychological comorbidity may need to be referred to healthcare professionals that are specialists in the area of psychological management, as they may require more intensive monitoring and treatment of a behavioural and psychological nature.
Chapter 28)
