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Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

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Pogosova, Nana, Saner, Hugo, Pedersen, Susanne S, Cupples, Margaret E, McGee, Hannah, Höfer, Stefan, Doyle, Frank, Schmid, Jean-Paul, von Känel, Roland, on behalf of the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology·2015·European Journal of Preventive Cardiology

DOI 10.1177/2047487314543075

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Abstract

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.

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Authors: Pogosova, N., Saner, H., Pedersen, S. S., Cupples, M. E., McGee, H., Höfer, S., Doyle, F., Schmid, J.-P., von Känel, R., & on behalf of the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology
Affiliations: Federal Health Center and Department of Internal Disease Prevention , National Research Center for Preventive Medicine, Russia
University Hospital of Bern (CH)
University of Southern Denmark (DK)
Queen's University Belfast (GB)
Royal College of Surgeons in Ireland (IE)
Innsbruck Medical University (AT)
Department of Neurology , Bern University Hospital, Switzerland
ORCID: Saner, Hugo
Pedersen, Susanne S
Cupples, Margaret E
McGee, Hannah
Höfer, Stefan
Doyle, Frank
Schmid, Jean-Paul
Venue: European Journal of Preventive Cardiology
Publisher: Oxford University Press (OUP)
Published: 2015-10-01
Volume: 22
Issue: 10
Pages: 1290-1306
ISSN: 2047-4873 (ISSN-L)
2047-4881
DOI: 10.1177/2047487314543075
OpenAlex: W2107383633
Cited by: 292
References: 210
Citations by year: 2026: 13 · 2025: 10 · 2024: 26 · 2023: 26 · 2022: 41 · 2021: 24 · 2020: 31 · 2019: 28 · 2018: 27 · 2017: 28 · 2016: 26 · 2015: 9
FWCI: 15.09
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: European Journal of Preventive Cardiology (publishedVersion)
PubMed (publishedVersion)
Bern Open Repository and Information System (University of Bern) (submittedVersion)
Figshare (submittedVersion, cc-by-nc-sa)
Research Portal (Queen's University Belfast) (submittedVersion)
University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
Funders: Medical Research Council (MR/K023241/1)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Keywords: cardiac rehabilitation, psychosocial risk factors, coronary artery disease, depression, anxiety, social isolation, stress, Type D personality, health-related quality of life, psychotherapy, psychopharmacological treatment, psychological counselling, medication adherence, psychosocial assessment, mind-body problem
MeSH terms: Adaptation, Psychological, Cardiology, Cooperative Behavior, Heart Diseases, Humans, Interviews as Topic, Mental Health, Patient Care Team, Predictive Value of Tests, Prognosis, Psychiatric Status Rating Scales, Quality of Life, Surveys and Questionnaires, Risk Factors, Cost of Illness, Consensus, Interdisciplinary Communication

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Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

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