A WeChat platform program (WCPP) for full-process management of patients with cardiac valve interventional surgery based on psycho-cardiology: protocol of a mixed-method study.

BACKGROUND: Valvular heart disease is the third most common cardiovascular disease; it significantly diminishes patients' quality of life and imposes burdens on individuals, families, and healthcare systems. In recent years, psycho-cardiology has emerged as a prominent field in which to explore the link between mental illness and heart disease. This mixed-method study aims to assess the effectiveness of the WCPP, which includes hospital-to-home transitional care, remote intelligent monitoring, and decision aids, in improving the physical and mental health of patients. METHODS: A mixed-method study was conducted at a cardiac valve interventional surgery (CVIS) center in Southwest China. A total of 154 CVIS patients participated, with the intervention group receiving the WCPP and the control group following the traditional CVIS management program. Both groups were followed up at 1, 3, 6, and 12 months. The primary outcome is measured via the Chinese version of the 36-item Short Form Health Survey (SF-36). The Secondary outcomes included the 6-min walk test (6MWT), modified Barthel index (MBI), major adverse cardiovascular events (MACE), patient satisfaction, and length of hospital stay (LOS). Additionally, qualitative research will assess the psychological state and experiences of the patients. DISCUSSION: Our study is one of the few involving patients with CVIS and the first to apply psycho-cardiology through a full-process management platform. The study population is predominantly from Southwest China and includes a diverse range of demographic and socioeconomic backgrounds. Upon completion, this study will provide valuable insights into the use of a remote, full-process management platform for CVIS patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400081052. Registered on 21 February 2024. The trial complies with the SPIRIT and CONSORT guidelines.

Development and validation of a questionnaire on bodily experience in VAD patients (BE-S).

BACKGROUND: Little is known about the disturbance in bodily experience (BE) following ventricular assist device (VAD) implantation. The level of disturbance in BE serves as an indicator of the status of the patients' adaptation process to the device. This process encompasses coping with both the more affective, psychological conflicts and the more cognitive, practical challenges of living with the VAD. To provide an economical screening tool for everyday clinical practice, we refined and validated a questionnaire on BE in VAD patients. METHODS: Seven specific items were derived from clinical experience and presented to 365 VAD patients (85% male; time since implantation: 3-36 months). The item structure was examined using factor analyses and probabilistic test theory. Discriminant validity and change sensitivity were determined in relation to associated psychometric instruments. RESULTS: Four items were found to constitute the unidimensional bodily experience scale (BE-S). Besides a high internal consistency of the scale (ω = 0.86), the RMSEA of >0.01 indicates a very good model fit. The BE-S has high convergent validity with related constructs (Hospital Anxiety and Depression Scale, Kansas City Cardiomyopathy Questionnaire). Change sensitivity analyses proved the BE-S alone to be significantly sensitive to the temporal dynamics of psychological adaptation processes following VAD implantation. CONCLUSION: The BE-S constitutes a valid and economical tool for clinical practice to assess patients' disturbance in BE after VAD implantation. It is a valuable tool for identifying patients with difficulties in adapting to the VAD. Subsequently, it enables early and focused therapeutic support for these patients at risk.

Prevalence and correlates of anxiety and depressive symptoms after Spontaneous Coronary Artery Dissection (SCAD): a cross-sectional study.

AIMS: Spontaneous coronary artery dissection (SCAD) is recognised as a particularly stressful cause of heart attack. However few studies have documented the prevalence of post-SCAD anxiety and depressive symptoms, or identified patients most at risk. This study documents the prevalence and correlates of post-SCAD anxiety and depressive symptoms. METHOD AND RESULTS: 310 (95% women) SCAD survivors were recruited by the Victor Chang Cardiac Research Institute from a database of 433 SCAD survivors. Participants completed an online questionnaire to gather demographic, medical and psychosocial information, including the Generalised Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Bivariate and multivariate analyses were undertaken to identify the significant demographic, psychosocial and medical correlates of post-SCAD anxiety and depressive symptoms. Time between SCAD and questionnaire completion varied from 2 months to 18 years (mean = 5.5 years; SD = 3.5 years). Rates of anxiety and depressive symptoms were 20.7% (GAD-7 ≥ 10) and 20.9% (PHQ-9 ≥ 10) respectively, and did not vary by time since event. In bivariate analyses, correlates (p < .05) of anxiety and depressive symptoms were absence of a close confidante, financial strain, mental health diagnosis pre-SCAD, comorbid obesity, not being in paid employment (anxiety only), younger age (depression only), and not knowing another SCAD survivor (depression only). Variables retained in multivariate models were absence of a close confidante, financial strain, not being in paid employment, mental health diagnosis pre-SCAD (depression only), and younger age (depression only). CONCLUSION: This study demonstrated that over one in four SCAD survivors experience either anxiety or depressive symptoms after SCAD, and identified those who may need additional support in their psychological recovery.

Heart failure potentially affects the cortical structure of the brain.

BACKGROUND: Heart failure (HF) has been reported to affect cerebral cortex structure, but the underlying cause has not been determined. This study used Mendelian randomization (MR) to reveal the causal relationship between HF and structural changes in the cerebral cortex. METHODS: HF was defined as the exposure variable, and cerebral cortex structure was defined as the outcome variable. Inverse-variance weighted (IVW), MR-Egger regression and weighted median (WME) were performed for MR analysis; MR-PRESSO and Egger's intercept was used to test horizontal pleiotropy; and "leave-one-out" was used for sensitivity analysis. RESULTS: Fifty-two single nucleotide polymorphisms (SNPs) were defined as instrumental variables (IVs), and there was no horizontal pleiotropy in the IVs. According to the IVW analysis, the OR and 95% CI of cerebral cortex thickness were 0.9932 (0.9868-1.00) (P=0.0402), and the MR-Egger intercept was -15.6× 10-5 (P = 0.7974) and the Global test pval was 0.078. The P-value of the cerebral cortex surface was 0.2205, and the MR-Egger intercept was -34.69052 (P= 0.6984) and the Global Test pval was 0.045. HF had a causal effect on the surface area of the caudal middle frontal lobule (P=0.009), insula lobule (P=0.01), precuneus lobule (P=0.049) and superior parietal lobule (P=0.044). CONCLUSIONS: HF was potentially associated with changes in cortical thickness and in the surface area of the caudal middle frontal lobule, insula lobule, precuneus lobule and superior parietal lobule.

Exploration of therapeutic models for psycho-cardiology: From cardiac to psychological rehabilitation.

The prevalence and mortality of cardiovascular disease are relatively high. Currently, depression has been proven to be an independent risk factor for the occurrence and poor prognosis of cardiovascular disease. Psycho-cardiovascular comorbidity, as a reciprocal cause and effect, affects each other, leading to the deterioration of clinical prognosis and forming a vicious circle. Coronary artery disease comorbidity with depression is a common disease in psycho-cardiology medicine. This paper expounds on the exploration of the treatment model of psycho-cardiology from the aspects of epidemiological characteristics, comorbidity mechanism, screening, diagnosis, and treatment.

Gut microbiota connects the brain and the heart: potential mechanisms and clinical implications.

Nowadays, high morbidity and mortality of cardiovascular diseases (CVDs) and high comorbidity rate of neuropsychiatric disorders contribute to global burden of health and economics. Consequently, a discipline concerning abnormal connections between the brain and the heart and the resulting disease states, known as psychocardiology, has garnered interest among researchers. However, identifying a common pathway that physicians can modulate remains a challenge. Gut microbiota, a constituent part of the human intestinal ecosystem, is likely involved in mutual mechanism CVDs and neuropsychiatric disorder share, which could be a potential target of interventions in psychocardiology. This review aimed to discuss complex interactions from the perspectives of microbial and intestinal dysfunction, behavioral factors, and pathophysiological changes and to present possible approaches to regulating gut microbiota, both of which are future directions in psychocardiology.

[Syndrome differentiation and treatment of coronary heart disease combined with anxiety and depression from stages of phlegm, blood stasis, and toxic pathogen based on theory of "coexistence of diseases and depression syndromes"].

Depression syndromes(anxiety and depression), as typical psychological disorders, often coexist with and mutually influence coronary heart disease(CHD). They constitute a psycho-cardiology disease involving both the blood vessels of the heart and the spirit of the heart. Based on the theory of "coexistence of diseases and depression syndromes", it was proposed that CHD and depression syndromes coexisted independently and were causally related. The factors of depression syndromes go through the entire course of CHD and have different causal relationships at different stages, leading to a pathogenic process of "depression causing disease" or "disease causing depression". In the chronic latent period, phlegm predominates, with depression leading to the production of phlegm. Phlegm accumulation and Qi stagnation initiate a mutual damage process of psycho-cardiology, marking the onset of the disease. In the pathological development period, blood stasis becomes predominant. Depression leads to blood stasis, which further obstructs Qi circulation, accelerating disease progression. In the acute attack period, toxicity becomes crucial. Depression transforms into toxicity, damaging Qi and blood, disturbing the balance of the mind, and inducing a sudden and severe exacerbation of the disease. Based on this, the approach of treating phlegm and depression together, treating blood stasis and depression together, and treating toxicity and depression together by stages was established. Research has found that this approach can simultaneously improve organic damage and emotional disorders, and also has a regulating effect on micro-level syndrome indicators, achieving harmonization of psycho-cardiology in the treatment.

Improving mental well-being in psychocardiology-a feasibility trial for a non-blended web application as a brief metacognitive-based intervention in cardiovascular disease patients.

Background: Many patients with cardiovascular disease also show a high comorbidity of mental disorders, especially such as anxiety and depression. This is, in turn, associated with a decrease in the quality of life. Psychocardiological treatment options are currently limited. Hence, there is a need for novel and accessible psychological help. Recently, we demonstrated that a brief face-to-face metacognitive therapy (MCT) based intervention is promising in treating anxiety and depression. Here, we aim to translate the face-to-face approach into digital application and explore the feasibility of this approach. Methods: We translated a validated brief psychocardiological intervention into a novel non-blended web app. The data of 18 patients suffering from various cardiac conditions but without diagnosed mental illness were analyzed after using the web app over a two-week period in a feasibility trial. The aim was whether a non-blended web app based MCT approach is feasible in the group of cardiovascular patients with cardiovascular disease. Results: Overall, patients were able to use the web app and rated it as satisfactory and beneficial. In addition, there was first indication that using the app improved the cardiac patients' subjectively perceived health and reduced their anxiety. Therefore, the approach seems feasible for a future randomized controlled trial. Conclusion: Applying a metacognitive-based brief intervention via a non-blended web app seems to show good acceptance and feasibility in a small target group of patients with CVD. Future studies should further develop, improve and validate digital psychotherapy approaches, especially in patient groups with a lack of access to standard psychotherapeutic care.

Impact of antidepressant use on the autonomic nervous system: A meta-analysis and systematic review.

Changes in cardiac autonomic nervous system (ANS) regulation observed in psychiatric disorders may be mitigated by antidepressants. We meta-analyzed and systematically reviewed studies examining antidepressants' effects on ANS outcomes, including heart rate variability (HRV). We conducted a PRISMA/MOOSE-compliant search of PubMed and Scopus until March 28th, 2022. We included randomized placebo-controlled trials (RCTs) and pre-post studies, regardless of diagnosis. We pooled results in random-effects meta-analyses, pooling homogeneous study designs and outcomes. We conducted sensitivity analyses and assessed quality of included studies. Thirty studies could be meta-analyzed. Selective serotonin reuptake inhibitors (SSRIs) were significantly associated with a reduction in the square root of the mean-squared difference between successive R-R intervals (RMSSD) (SMD= -0.48) and skin conductance response (SMD= -0.55) in RCTs and with a significant increase in RMSSD in pre-post studies (SMD=0.27). In pre-post studies, tricyclic antidepressants (TCAs) were associated with a significant decrease in several HRV outcomes while agomelatine was associated with a significant increase in high frequency power (SMD= 0.14). In conclusion, SSRIs reduce skin conductance response but have no or inconclusive effects on other ANS outcomes, depending on study design. TCAs reduce markers of parasympathetic function while agomelatine might have the opposite effect. Studies are needed to investigate the impact of SSRIs on the recovery of cardiac ANS regulation after acute myocardial infarction, and the effects of newer antidepressants.

Donor and Donation Images (DDI)-A Scoping Review of What We Know and What We Don't.

Organ transplantation is associated with significant physical and psychological burden for the recipients. Qualitative reports indicate that organ recipients develop donor and donation images (DDI)-conceptions of the donor and/or the organ. A deeper understanding of DDI is needed in the care of transplant recipients. To present the current state of knowledge, we searched for and identified DDI-related publications in PubMed and Scopus. Inclusion criteria were (1) studies addressing transplant recipients, and (2) English or German language. Twenty-one studies of individuals with transplanted hearts, lungs, or kidneys were included in this scoping review. Prevalence for DDI ranged from 6% to 52.3%. DDI occurs both before and after transplantation and includes ideas about the donor as well as whether and how the recipient's personality may be altered by the transplanted organ. Some transplant recipients did indeed report personality changes following transplantation due to the adoption of assumed donor characteristics. One study showed a positive association between the presence of DDI and anxiety scores and one described a coping effect. DDI is understudied and should be systematically assessed to improve care for the vulnerable group of individuals undergoing organ transplantation. Current research gaps and future directions are discussed.

Psycho-Cardiological Disease in COVID-19 Era.

During the coronavirus disease 2019 (COVID-19) pandemic, panic and public health responses, including self-monitored quarantine and lockdown of the city, have severely impacted mental health and caused depression or anxiety in citizens. Psycho-cardiology indicates that psychological factor plays an important role in coronary heart disease (CHD). COVID-19, depression and CHD can co-exist and deleteriously affect each other, leading to worse progression and prognosis. Delays in medical consultation and treatment have become more common than before the pandemic, inducing more cardiovascular (CV) events and sequelae. COVID-19 survivors have been identified to have more psycho-cardiological symptoms compared with non-COVID-19 controls. Undoubtedly, diet alterations and sedentary lifestyles during the pandemic will cause and aggravate psycho-cardiological diseases. Some frequently used cardiovascular drugs were found to associate with changes in depression. With the advent of the post-pandemic era, although the acute damage of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is gradually declining, the psycho-cardiological diseases related to the novel coronavirus are becoming increasingly prominent. So it is an important issue for us to explore the pathogenesis, clinical manifestations and corresponding preventive measures of this aspect.

Heart Rate Variability: A Measure of Cardiovascular Health and Possible Therapeutic Target in Dysautonomic Mental and Neurological Disorders.

Mental illness such as depression and anxiety as well as cerebrovascular disease are linked to impairment of neurocardiac function mediated by changes to the autonomic nervous system with increased sympathetic and decreased parasympathetic activity. Autonomic neurocardiac function can be evaluated by computing heart rate variability (HRV). Over the past decades, research has demonstrated the diagnostic value of HRV as independent predictor of cardiovascular mortality and as disease marker in progressive autonomic nervous system disorders such as Parkinson's disease. Here we summarize our studies on HRV and its therapeutic modulation in the context of psychopharmacology as well as psychiatric and neurological disorders to honor the life of Professor Evgeny Vaschillo, the true pioneer of HRV research who sadly passed away on November 21st, 2020.

Sex-specific psychological risk profiles of CVD in the HUNT study: the role of neuroticism and extraversion.

OBJECTIVE: The aim was to investigate psychological risk profiles of cardiovascular disease (CVD). Depression and anxiety have been linked to CVD, but research has not incorporated personality and sex-specific analyses are warranted. In this study, we examine the role of sex, neuroticism, extraversion, anxiety and depression on the risk of CVD. METHOD: Using data from the HUNT-study and the mortality register, 32,383 (57.10% men) participants were followed for an average of 10.48 years. During this time, 142 died of myocardial infarction (MI) and 111 of stroke. RESULTS: Cox regression showed that depression (HR = 1.07, 95% CI = [1.00, 1.14]) and neuroticism (1.23 [1.08, 1.40]) were significantly related to an increased risk of MI. One standard unit increase in depression and neuroticism was associated with 1.22 [CI 1.01, 1.47] increase and 1.43 [CI 1.14, 0.78] increase in the risk of MI respectively. For stroke, there was no significant effect of anxiety, depression or personality. However, we found a significant interaction effect between sex and extraversion where higher extraversion was associated with greater risk of stroke for women only. CONCLUSIONS: Both neuroticism and depression were related to MI. We observed an interaction between extraversion and sex with stroke, but the effect size was small. The role of extroversion as a risk factor for CVD remains inconclusive.

Changes in treatment outcomes in patients undergoing an integrated psychosomatic inpatient treatment: Results from a cohort study.

Objective: In Germany, multimodal psychosomatic inpatient treatment can be initiated for patients with substantial mental disorders (e.g., depression, anxiety, somatoform disorders) and comorbid physical disease. However, studies investigating changes in psychological and functional treatment outcomes, and predictors of long-term treatment effects in patients undergoing psychosomatic inpatient treatment are needed. Methods: This cohort study analyzed 160 patients aged ≥18 who were treated on an integrated psychosomatic inpatient unit at the University of Göttingen Medical Center. Its aim was to analyze changes in psychological and functional outcomes, and to identify predictors of long-term improvements in health-related quality of life (HRQoL) in patients with comorbid mental and physical illness who were undergoing integrated inpatient psychosomatic treatment. Assessments were completed at admission, discharge, and 12- or 24-month follow-up. Outcomes included physical complaints [Giessen Subjective Complaints List (GBB-24)], psychological symptoms [Brief Symptom Inventory (BSI)], and HRQoL [European Quality of Life Questionnaire (EQ-5D)]. Results: One-hundred sixty inpatients were included (mean age = 53.1 ± 12.6; 53.8% female). There were significant, medium- to large-sized improvements in psychological symptoms (BSI-Global Severity Index; d = -0.83, p < 0.001), physical symptom burden (d = -0.94, p < 0.001), and HRQoL (d = 0.65, p < 0.001) from admission to discharge, and significant, small- to medium-sized greater improvements in all psychological outcomes from admission to follow-up (BSI-GSI: d = -0.54, p < 0.001; GBB-24 total symptom burden: d = -0.39, p < 0.001; EQ-5D: d = 0.52, p < 0.001). Furthermore, better improvement in HRQoL during hospitalization (partial η2 = 0.386; p < 0.001) was associated with higher HRQoL at follow-up. Finally, intake of antidepressant at discharge was associated with impaired HRQoL at follow-up (η2 = 0.053; p = 0.03). Conclusion: There were significant short- and long-term improvements in psychological symptoms, physical complaints, and HRQoL after treatment on an integrated psychosomatic inpatient unit in patients with mental disorders and a comorbid physical disease.

Factors associated with psychological resilience in patients with chronic heart failure and efficacy of psycho-cardiology intervention.

OBJECTIVE: To explore the value of psycho-cardiology intervention on psychological resilience in patients with chronic heart failure (CHF) and investigate the associated factors. METHODS: A retrospective study of 142 patients with CHF was carried out. These patients were admitted to the Department of Cardiology, Provincial Clinical Medical College of Fujian Medical University from January 2017 to January 2021. They were grouped according to intervention method, including 74 patients with psycho-cardiology intervention and 68 with conventional intervention. The psychological resilience and the levels of anxiety and depression before and after intervention were assessed with the Connor-Davidson resilience scale (CD-RISC), self-rating anxiety scale (SAS), and self-rating depression scale (SDS), respectively. The factors associated with psychological resilience in patients with CHF were observed. The relationship between psychological resilience and SAS scores before intervention was studied. RESULTS: Using multivariate logistic regression analysis, we found that age (OR (95% CI): 3.452 (0.862-4.872), P=0.015), gender (OR, (95% CI): 3.389 (0.872-5.023), P=0.035), SAS score (OR (95% CI) 5.433 (1.543-14.333), P=0.027) and SDS score (OR (95% CI): 5.654 (1.572-15.823), P=0.021) were factors associated with psychological resilience in patients with CHF (all P<0.05). The average CD-RISC scores were 56.55±8.89 points in patients with CHF. The psychological resilience was inversely correlated with SAS score (r=-0.450, P<0.001) and SDS scores (r=-0.401, P<0.001). The CD-RISC scores of the observation group after intervention were higher than before intervention and higher than the control group, while SAS and SDS scores were decreased (all P<0.05). CONCLUSION: Age, gender, SAS, and SDS scores are factors associated with psychological resilience in patients with CHF. Psychological resilience was inversely associated with both anxiety and depression. Psycho-cardiology intervention can improve patients' psychological resilience, and reduce their anxiety and depression.

Heart-Focused Anxiety Affects Behavioral Cardiac Risk Factors and Quality of Life: A Follow-Up Study Using a Psycho-Cardiological Rehabilitation Concept.

Background: Heart-focused anxiety (HFA) raises the risk for adverse outcomes in patients with heart disease. Despite this great importance, it is rarely assessed in clinical practice. Three dimensions are commonly defined in the context of HFA: heart-related fear, avoidance, and attention. The impact of these aspects on cardiac risk factors is essentially unclear. In this study, we investigated the relationship between HFA and behavioral cardiac risk factors as well as health-related quality of life (HRQoL), which represent important treatment outcomes of inpatient psycho-cardiological rehabilitation. Methods: A prospective observational design was used to examine 238 rehabilitation inpatients with comorbidity of cardiac disease and psychiatric disorder. We assessed HFA using the Cardiac Anxiety Questionnaire (CAQ), HRQoL using the SF-12 Health Survey, exercise capacity using the 6-minute walk test, and smoking behavior, respectively at admission (t0) and discharge (t1). Physical activity was assessed at t0 and in a follow-up survey 6 months after discharge (t2) using the International Physical Activity Questionnaire (IPAQ). Multiple regression models were used to analyze the predictive value of HFA for the outcome variables at t0, t1, and t2, adjusted for socio-demographic factors and depression. Predictive values for changes over time were evaluated by the regressor variable approach. Results: Exercise capacity and physical activity were negatively predicted by baseline heart-related avoidance, both cross-sectionally and prospectively. Avoidance at t1 also negatively predicted long-term changes over time in physical activity at t2. Total HFA and the subcomponent avoidance negatively predicted physical HRQoL both cross-sectionally and prospectively. Mental HRQoL was cross-sectionally predicted by heart-focused attention at t0, and prospectively predicted by total HFA and by avoidance. Regarding changes in the course of rehabilitation, baseline avoidance negatively predicted improvement in physical HRQoL during rehabilitation. Concerning smoking behavior, no associations with HFA were found. Conclusions: HFA is a relevant inhibiting factor for the achievement of therapy goals in psycho-cardiological rehabilitation such as health behavior and HRQoL. Heart-related avoidance in particular, has a negative impact on exercise capacity, physical activity, and self-reported physical health. Its prospective negative predictive value for physical activity and physical health underlines the relevance of HFA for psycho-cardiological interventions.

[Psychocardiological intervention in the cardiovascular rehabilitation of school children with congenital heart disease: A systematic review]. / La intervención psicocardiológica en la rehabilitación cardiovascular de niños escolares con cardiopatías congénitas: una revisión sistemática.

OBJECTIVE: A systematic review is presented with the objective of determining whether school children with congenital heart disease participate in psychological interventions in the cardiovascular rehabilitation process. METHOD: Guided review by the PRISMA method was carried out in the databases: Dialnet, Pub Med, Redalyc, Science Direct, Scielo, Google Academic of articles published in English, Portuguese and Spanish. The inclusion criteria are: rehabilitative interventions that contain actions for the management of psychological factors. 23 reports were evaluated for eligibility, only 1 was chosen through the data tabulation method. RESULTS: It was evidenced that these programs for children with heart disease are scarce, they focus on physical activity, neglecting socio-psychological variables. It is proposed to implement standardized intervention actions with congenital cardiovascular patients and their families from psychocardiology according to their needs.