Abstract
Psychological and behavioral factors increase risk for primary cardiovascular disease (CVD) and worsen prognosis and quality of life among patients with CVD. The current paper highlights the unique psychological, behavioral, and psychosocial challenges faced by patients with CVD, particularly among vulnerable and historically marginalized populations, and offers recommendations and considerations for evidence-based treatments. A case example is utilized to illustrate the biopsychosocial experience of CVD and related treatment, as well as the opportunities for psychosocial and behavioral interventions. Psychologists with specialized training in cardiac psychology are uniquely positioned to address these risk factors, collaborate with interdisciplinary teams in diverse medical settings, and significantly improve patients’ cardiovascular health and quality of life.
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Aggarwal, N. K., & Lewis-Fernández, R. (2020). An Introduction to the Cultural Formulation Interview. FOCUS, 18(1), 77–82. https://doi.org/10.1176/appi.focus.18103
Allan, R. & Fisher, J. (Eds.). (2011). Heart and mind: The practice of cardiac psychology (Second Edition). American Psychological Association. https://doi.org/10.1037/13086-000
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
APA Services. (2019). Health Behavior Assessment and Intervention CPT Codes for Psychologists. American Psychological Association Services, Inc.
Banerjee, S., Cader, F. A., Gulati, M., & Capers, Q. (2021). Racism and Cardiology: A Global Call to Action. CJC Open, 3(12), S165–S173. https://doi.org/10.1016/j.cjco.2021.09.014
Bashiri, Z., Aghajani, M., & Alavi, N. M. (2016). Effects of psychoeducation on mental health in patients with coronary heart disease. Iranian Red Crescent Medical Journal, 18(5).
Bock, C., Diehl, K., Schneider, S., Diehm, C., & Litaker, D. (2012). Behavioral Counseling for Cardiovascular Disease Prevention in Primary Care Settings: A Systematic Review of Practice and Associated Factors. Medical Care Research and Review, 69(5), 495–518. https://doi.org/10.1177/1077558712441084
Borne, R. T., Varosy, P. D., & Masoudi, F. A. (2013). Implantable Cardioverter-Defibrillator Shocks: Epidemiology, Outcomes, and Therapeutic Approaches. JAMA Internal Medicine, 173(10), 859–865. https://doi.org/10.1001/jamainternmed.2013.428
Breathett, K., Yee, E., Pool, N., Hebdon, M., Crist, J. D., Knapp, S., Larsen, A., Solola, S., Luy, L., Herrera‐Theut, K., Zabala, L., Stone, J., McEwen, M. M., Calhoun, E., & Sweitzer, N. K. (2019). Does Race Influence Decision Making for Advanced Heart Failure Therapies? Journal of the American Heart Association, 8(22), e013592. https://doi.org/10.1161/JAHA.119.013592
Brunetti, N. D., Guerra, A., Ieva, R., Correale, M., Santoro, F., Tarantino, N., & Di Biase, M. (2017). Scared for the scar: Fearsome impact of acute cardiovascular disease on perceived kinesiophobia (fear of movement). Clinical Cardiology, 40(7), 480–484. https://doi.org/10.1002/clc.22682
Burg, M. M. (2018). Psychological treatment of cardiac patients. American Psychological Association.
Burg, M. M., & Stewart, J. C. (2022). If not us, who? If not now, when? Paths forward in science, patient care, and training to maximize the impact of cardiovascular behavioral medicine. Health Psychology, 41(10), 643.
Capers, Q., & Sharalaya, Z. (2014). Racial disparities in cardiovascular care: A review of culprits and potential solutions. Journal of Racial and Ethnic Health Disparities, 1(3), 171–180.
Celano, C. M., Millstein, R. A., Bedoya, C. A., Healy, B. C., Roest, A. M., & Huffman, J. C. (2015). Association between anxiety and mortality in patients with coronary artery disease: A meta-analysis. American Heart Journal, 170(6), 1105–1115.
Celano, C. M., Daunis, D. J., Lokko, H. N., Campbell, K. A., & Huffman, J. C. (2016). Anxiety disorders and cardiovascular disease. Current Psychiatry Reports, 18(11), 1–11.
Chavez, C. A., Ski, C. F., & Thompson, D. R. (2014). Psychometric properties of the cardiac depression scale: a systematic review. Heart, Lung and Circulation, 23(7), 610-618.
Churchwell, K., Elkind, M. S. V., Benjamin, R. M., Carson, A. P., Chang, E. K., Lawrence, W., Mills, A., Odom, T. M., Rodriguez, C. J., Rodriguez, F., Sanchez, E., Sharrief, A. Z., Sims, M., Williams, O., & null, null. (2020). Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: A Presidential Advisory From the American Heart Association. Circulation, 142(24), e454–e468.https://doi.org/10.1161/CIR.0000000000000936
Clancy, F., Prestwich, A., Caperon, L., Tsipa, A., & O’Connor, D. B. (2020). The association between worry and rumination with sleep in non-clinical populations: A systematic review and meta-analysis. Health Psychology Review, 14(4), 427–448.
Collopy, C. M., Cosh, S. M., & Tully, P. J. (2021). Screening and referral is not enough: A qualitative exploration of barriers to access and uptake of mental health services in patients with cardiovascular diseases. BMC Health Services Research, 21(1), 1–11.
Conway, A., Sheridan, J., Maddicks-Law, J., Fulbrook, P., Ski, C. F., Thompson, D. R., & Doering, L. V. (2016). Accuracy of anxiety and depression screening tools in heart transplant recipients. Applied Nursing Research, 32, 177-181.
Cousin, L., Redwine, L., Bricker, C., Kip, K., & Buck, H. (2021). Effect of gratitude on cardiovascular health outcomes: A state-of-the-science review. The Journal of Positive Psychology, 16(3), 348–355. https://doi.org/10.1080/17439760.2020.1716054
Day, F. R., Elks, C. E., Murray, A., Ong, K. K., & Perry, J. R. (2015). Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: The UK Biobank study. Scientific Reports, 5(1), 1–12.
de Waure, C., Lauret, G.-J., Ricciardi, W., Ferket, B., Teijink, J., Spronk, S., & Myriam Hunink, M. G. (2013). Lifestyle Interventions in Patients with Coronary Heart Disease: A Systematic Review. American Journal of Preventive Medicine, 45(2), 207–216. https://doi.org/10.1016/j.amepre.2013.03.020
DuBois, C. M., Lopez, O. V., Beale, E. E., Healy, B. C., Boehm, J. K., & Huffman, J. C. (2015). Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: A systematic review. International Journal of Cardiology, 195, 265–280. https://doi.org/10.1016/j.ijcard.2015.05.121
Eberly, L. A., Richterman, A., Beckett, A. G., Wispelwey, B., Marsh, R. H., Cleveland Manchanda, E. C., Chang, C. Y., Glynn, R. J., Brooks, K. C., Boxer, R., Kakoza, R., Goldsmith, J., Loscalzo, J., Morse, M., Lewis, E. F., null, null, Abel, S., Adams, A., Anaya, J., … Zon, R. (2019). Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center. Circulation: Heart Failure, 12(11), e006214. https://doi.org/10.1161/CIRCHEARTFAILURE.119.006214
Elbashir, M., Awaisu, A., El Hajj, M. S., & Rainkie, D. C. (2019). Measurement of health literacy in patients with cardiovascular diseases: a systematic review. Research in Social and Administrative Pharmacy, 15(12), 1395-1405.
Fatehi Hassanabad, A., Bahrami, N., Novick, R. J., & Ali, I. S. (2021). Delirium and depression in cardiac surgery: A comprehensive review of risk factors, pathophysiology, and management. Journal of Cardiac Surgery, 36(8), 2876–2889.
Fraser, A., Catov, J. M., Lawlor, D. A., & Rich-Edwards, J. W. (2018). Pregnancy characteristics and women’s cardiovascular health. Handbook of Life Course Health Development, 145–165.
Frasure-Smith, N., & Lesperance, F. (2008). Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Archives of General Psychiatry, 65(1), 62–71.
Gagnon, C., Saillant, K., Olmand, M., Gayda, M., Nigam, A., Bouabdallaoui, N., ... & Bherer, L. (2022). Performances on the montreal cognitive assessment along the cardiovascular disease continuum. Archives of Clinical Neuropsychology, 37(1), 117–124.
Garcia, M., Mulvagh, S. L., Bairey Merz, C. N., Buring, J. E., & Manson, J. E. (2016). Cardiovascular disease in women: Clinical perspectives. Circulation Research, 118(8), 1273–1293.
Graham, G. (2015). Disparities in Cardiovascular Disease Risk in the United States. Current Cardiology Reviews, 11(3), 238–245. https://doi.org/10.2174/1573403X11666141122220003
Hunter, C. L., Funderburk, J. S., Polaha, J., Bauman, D., Goodie, J. L., & Hunter, C. M. (2018). Primary Care Behavioral Health (PCBH) model research: Current state of the science and a call to action. Journal of Clinical Psychology in Medical Settings, 25(2), 127–156.https://doi.org/10.1007/s10880-017-9512-0
Jilani, M. H., Javed, Z., Yahya, T., Valero-Elizondo, J., Khan, S. U., Kash, B., Blankstein, R., Virani, S. S., Blaha, M. J., & Dubey, P. (2021). Social determinants of health and cardiovascular disease: Current state and future directions towards healthcare equity. Current Atherosclerosis Reports, 23(9), 1–11.
Johnson, A. E., Adhikari, S., Althouse, A. D., Thoma, F., Marroquin, O. C., Koscumb, S., Hausmann, L. R. M., Myaskovsky, L., & Saba, S. F. (2018). Persistent sex disparities in implantable cardioverter-defibrillator therapy. Pacing and Clinical Electrophysiology, 41(9), 1150–1157. https://doi.org/10.1111/pace.13435
Kubzansky, L. D., Huffman, J. C., Boehm, J. K., Hernandez, R., Kim, E. S., Koga, H. K., Feig, E. H., Lloyd, -Jones Donald M., Seligman, M. E. P., & Labarthe, D. R. (2018). Positive Psychological Well-Being and Cardiovascular Disease. Journal of the American College of Cardiology, 72(12), 1382–1396. https://doi.org/10.1016/j.jacc.2018.07.042
Lloyd-Jones, D. M., Allen, N. B., Anderson, C. A., Black, T., Brewer, L. C., Foraker, R., Grander, M. A., Lavretsky, H., Marma Perak, A., Sharma, G., Rosamond, W., & American Heart Association. (2022). Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation, 146(5), e18–e43.https://doi.org/10.1161/CIR.0000000000001078
Loucks, E. B., Schuman-Olivier, Z., Britton, W. B., Fresco, D. M., Desbordes, G., Brewer, J. A., & Fulwiler, C. (2015). Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework. Current Cardiology Reports, 17(12), 112. https://doi.org/10.1007/s11886-015-0668-7
Mavrides, N., & Nemeroff, C. (2013). Treatment of Depression in Cardiovascular Disease. Depression and Anxiety, 30(4), 328–341. https://doi.org/10.1002/da.22051
Mosca, L., Benjamin, E. J., Berra, K., Bezanson, J. L., Dolor, R. J., Lloyd-Jones, D. M., Newby, L. K., Pina, I. L., Roger, V. L., & Shaw, L. J. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: A guideline from the American Heart Association. Circulation, 123(11), 1243–1262.
Ruiz, J. M., Hutchinson, J. G., & Terrill, A. L. (2008). For better and worse: Social influences on coronary heart disease risk. Social and Personality Psychology Compass, 2(3), 1400–1414.
Sears, S. F., & Conti, J. B. (2002). Quality of life and psychological functioning of ICD patients. Heart, 87(5), 488-493.
Sears, S. F., Shea, J. B., & Conti, J. B. (2005). How to Respond to an Implantable Cardioverter-Defibrillator Shock. Circulation, 111(23), e380–e382. https://doi.org/10.1161/CIRCULATIONAHA.104.508663
Sears, S. F., Hauf, J. D., Kirian, K., Hazelton, G., & Conti, J. B. (2011). Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient. Circulation: Arrhythmia and Electrophysiology, 4(2), 242–250. https://doi.org/10.1161/CIRCEP.110.957670
Shah, N. S., Ning, H., Petito, L. C., Kershaw, K. N., Bancks, M. P., Reis, J. P., Rana, J. S., Sidney, S., Jacobs Jr, D. R., & Kiefe, C. I. (2022). Associations of clinical and social risk factors with racial differences in premature cardiovascular disease. Circulation, 146(3), 201–210.
Sickel, A. E., Seacat, J. D., & Nabors, N. A. (2019). Mental health stigma: Impact on mental health treatment attitudes and physical health. Journal of Health Psychology, 24(5), 586–599.
Silverman, A. L., Herzog, A. A., & Silverman, D. I. (2019). Hearts and Minds: Stress, Anxiety, and Depression: Unsung Risk Factors for Cardiovascular Disease. Cardiology in Review, 27(4), 202–207. https://doi.org/10.1097/CRD.0000000000000228
Tully, P. J., & Cosh, S. M. (2013). Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease: A meta-analysis. Journal of Health Psychology, 18(12), 1601–1616.
Vela, A., Gaffey, A., Carroll, A., Cavanagh, C., Dulin, A., Qunitilani, L., Hayman, L., & Burg, M. M. (2022). Increase Funding and Access for Intensive Behavioral Counseling to Reduce Cardiovascular Disease-Related Health Inequities. Society of Behavioral Medicine.
Wenger, N. K., Lloyd-Jones, D. M., Elkind, M. S. V., Fonarow, G. C., Warner, J. J., Alger, H. M., Cheng, S., Kinzy, C., Hall, J. L., Roger, V. L., & null, null. (2022). Call to Action for Cardiovascular Disease in Women: Epidemiology, Awareness, Access, and Delivery of Equitable Health Care: A Presidential Advisory From the American Heart Association. Circulation, 145(23), e1059–e1071.https://doi.org/10.1161/CIR.0000000000001071
Williams, R. B. (2011). Depression After Heart Attack. Circulation, 123(25), e639–e640. https://doi.org/10.1161/CIRCULATIONAHA.110.017285
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Alyssa M. Vela and Allison J. Carroll are co-first authors.
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Vela, A.M., Carroll, A.J. Cardiac Psychology: Psychosocial and Behavioral Assessment and Treatment for Cardiovascular Conditions. J Health Serv Psychol 49, 21–32 (2023). https://doi.org/10.1007/s42843-023-00079-8
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DOI: https://doi.org/10.1007/s42843-023-00079-8