Positive affect as a predictor of non-pharmacological adherence in older Chronic Heart Failure (CHF) patients undergoing cardiac rehabilitation.

In Chronic Heart Failure (CHF) patients, psychological and cognitive variables and their association with treatment adherence have been extensively reported in the literature, but few are the investigations in older people. The present study aimed to evaluate the psychological, cognitive, and adherence to treatment profile of older (>65 years) CHF patients, the interrelation between these variables, and identify possible independent predictors of self-reported treatment adherence. CHF inpatients undergoing cardiac rehabilitation were assessed for: anxiety, depression, cognitive impairment, positive and negative affect, and self-reported adherence (adherence antecedents, pharmacological adherence, and non-pharmacological adherence). 100 CHF inpatients (mean age: 74.9 ± 7.1 years) were recruited. 16% of patients showed anxiety and 24.5% depressive symptoms; 4% presented cognitive decline. Cognitive functioning negatively correlated to depression, anxiety, and negative affect (p < 0.01). The adherence antecedents (disease acceptance, adaptation, knowledge, and socio-familiar support) negatively correlated to anxiety (p < 0.05), depression (p < 0.001), and negative affect (p < 0.05), while they positively correlated to positive affect (p < 0.01). Pharmacological adherence negatively correlated to anxiety and negative affect (p < 0.05). Conversely, non-pharmacological adherence and positive affect positively correlated (p < 0.05). Furthermore, depression and anxiety negatively predicted adherence antecedents (ß = -0.162, p = 0.037) and pharmacological adherence (ß = -0.171, p = 0.036), respectively. Finally, positive affect was found as an independent predictor of non-pharmacological adherence (ß = 0.133, p = 0.004). In cardiac rehabilitation, a specific psychological assessment focused on anxiety, depression, and affect can provide useful information to manage CHF older patients' care related to treatment adherence. In particular, positive affect should be targeted in future interventions to foster patients' non-pharmacological adherence.

Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial.

AIMS: This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). METHODS AND RESULTS: For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n = 98; CTEPH n = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17-33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18-51 m; P < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 ± 2.5, P = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; χ2P = 0.027) and peak oxygen consumption (0.9 ± 0.5 mL/min/kg, P = 0.048) compared with the control group. CONCLUSION: This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries.

Effects of an outpatient service holistic rehabilitation program in a case of pulmonary atresia.

A 42-year-old woman affected by pulmonary atresia came to our attention complaining of dyspnea and fatigue for minimal efforts with important desaturation. After assessing her basal functional capacity with a cardiopulmonary exercise test, the patient was enrolled in an extremely individualized rehabilitation program, which entailed a discreet improvement in the quality of life indices, in the absence of side effects. This paper shows that even patients with extremely severe forms of congenital heart disease, when clinical stable, can undergone a tailored cardiorespiratory rehabilitation program. This must be carried out in a monitored environment and under the supervision of expert personnel.

Mental health and risk perception among Italian healthcare workers during the second month of the Covid-19 pandemic.

A multicentre cross-sectional study was conducted to assess perceived risk and fear of contagion, as well as mental health outcomes among 650 Italian healthcare workers during the COVID-19 outbreak. A relevant proportion of the sample reported symptoms of anxiety, depression, and distress. Female sex, nursing profession, fear of being infected, as well as the time of exposure to the COVID-19 spread and the fact of directly attending infected patients were the main risk factors for developing mental health disturbances. Tailored interventions need to be implemented to reduce psychological burden in healthcare workers, with a particular attention to nurses.

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper.

Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on 'new' conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings.

[First definition of minimal care model: the role of nurses, physiotherapists, dietitians and psychologists in preventive and rehabilitative cardiology]. / Documento preliminare alla definizione degli interventi Minimal Care infermieristici, fisioterapici, dietistici e psicologici attuabili nell'ambito della Cardiologia Riabilitativa e Preventiva.

Rehabilitative and preventive cardiology (CRP) is configured as intervention prevention to "gain health" through a process of multifactorial care that reduces disability and the risk of subsequent cardiovascular events. It makes use of an interdisciplinary team in which every professional needs to have multiple intervention paths because of the different levels of clinical and functional complexity of cardiac patients who currently have access to the rehabilitation. The document refers to the use of interventions by nurses, physiotherapists, dietitians and psychologists that are part of the rehabilitation team of CRP. Interventions of which have been documented, on scientific bases and clinical practice, empirical effectiveness and organizational efficiency. The methodological approach of this paper is a first attempt to define, through the model of consensus, the minimum standards for a CRP evidence based characterized by clearly defined criteria that can be used by operators of CRP. The document describes the activities to be carried out in each of the phases included in the pathways of care by nurses, physiotherapists, dietitians and psychologists. The routes identified were divided, according to the type of patients who have access to the CRP and to the phases of care, including the initial assessment, intervention, evaluation and final reporting, in high medium and low complexity. Examples of models of reporting, used by the operators of the team according to the principles of good clinical practice, are provided. This is made to allow traceability of operations, encourage communication inside the working group and within the patient and the caregiver. Also to give any possible indication for the post-rehabilitation.

Post-traumatic stress disorder, depression and anxiety symptoms in COVID-19 outpatients with different levels of respiratory and ventilatory support in the acute phase undergoing three months follow-up.

BACKGROUND: The well-known COVID-19 pandemic totally transformed people's lives, paving the way to various psychopathological symptoms. In particular, patients may experience a short- and long-term decreasing in their wellbeing. In this vein, the aim of this paper was to assess the COVID-19 patients' psychopathological profile (post-traumatic stress disorder, distress, anxiety and depression symptoms), detecting possible differences linked to the ventilatory treatments. METHODS: Outpatients who recovered from COVID-19 were asked to provide socio-demographic and clinical information, and to complete a brief psychological screening evaluation (Impact of Event Scale-Revised [IES-R], Depression Anxiety Stress Scale [DASS-21]). RESULTS: Overall, after informed consent, 163 Italian patients took part in this research. Of them, 31.9% did not undergo any ventilatory therapy, 27.6% undertook oxygen therapy, 28.2% underwent noninvasive mechanical ventilation, and 12.3% received invasive mechanical ventilation. Although no statistically significant differences were revealed among patients stratified by spontaneous breathing or ventilatory therapies, they reported statistically significant more depression (4.5+5.2 vs. 3.5+3.2; P=0.017) and anxiety (4.3+4.5 vs. 2.4+2.6; P<0.00001) symptoms than normative groups. Moreover, patients experiencing COVID-19 disease as a trauma, complained statistically significant higher levels of depression, anxiety and stress symptoms than who did not describe a clinically relevant traumatic experience (P<0.001). CONCLUSIONS: Thus, this study suggests to healthcare professionals to consider COVID-19 experience as a potential real trauma for patients, and underlines the necessity to define patients' psychopathological profile in order to propose tailored and effective preventive and supportive psychological interventions.

Perceived Anxiety, Coping, and Autonomic Function in Takotsubo Syndrome Long after the Acute Event.

BACKGROUND: Anxiety and depressive disorders represent predisposing factors for the autonomic dysfunctions that characterize the acute phase of Takotsubo syndrome (TS). However, there is insufficient data on this relationship after the acute event. The present study aimed at evaluating the psychological and autonomic status of patients with a history of TS. METHODS: Ten TS patients whose acute event occurred at least 1 year prior to the evaluation and nine healthy age- and sex-matched subjects were evaluated. The cardiovascular assessment included a clinical examination, beat-to-beat heart rate monitoring to assess heart rate variability, and a psychological examination using the 16 Personality Factors-C Form (16PF), the Acceptance and Action Questionnaire-II, the Coping Orientations to Problems Experienced (COPE), the Beck Depression Inventory-II, and the State-Trait Anxiety Inventory (STAI). RESULTS: TS patients scored significantly higher on the STAI (i.e., Anxiety Trait), 16PF (i.e., Tension), and COPE (i.e., Transcendental Orientation). TS patients also showed lower heart rate variability. Moreover, a significant inverse correlation was found between sympathetic tone (LF/HF ratio) and coping orientation. CONCLUSIONS: Long after the acute event, TS patients are characterized by elevated anxiety, high tension, and a specific religious coping strategy.

Takotsubo syndrome in COVID-19 era: Is psychological distress the key?

Covid-19 pandemic, starting from Wuhan, China spread all over the world and Italy was one of the most affected countries, especially in Lombardy, where, on February 20, the first confirmed case was detected. Italian Government ordered a national lockdown on the 9 th March 2020, forcing the population to severe restrictive isolation measures. The burden on mental health of the medical emergency related to COVID19 is progressively been revealed. Takotsubo syndrome (TTS), is estimated to represent 1-3% of patients admitted with suspected STEMI, mostly affecting elderly women with emotional stress and/or acute illness preceding the presentation. Comparing patients hospitalised from February to May 2020 with those of the corresponding period in 2019 we observed a significantly increased number of TTS diagnosis in 2020 (11 patients vs 3 in 2019), especially during the first period of lockdown. The only two males were patients with COVID-19 and were the only two who died in hospital. At psychological examination all patients enrolled report to have lived a particularly stressful experience at IES-R in the last year, without presenting the symptoms of a post-traumatic stress disorder. Most patients were positive to the allostatic overload. Only one patient showed a clinical cut-off for HADS and no one for the Fear COVID-19 scale. We finally concluded that subjects with pre-pandemic psychological distress may have experienced additional psychological overload, opening the door to TTS by a series of physiological alterations as the secretion of cortisol and catecholamines, making the subject more vulnerable to the onset of TTS.

Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era.

This Delphi consensus by 28 experts from the European Association of Preventive Cardiology (EAPC) provides initial recommendations on how cardiovascular rehabilitation (CR) facilities should modulate their activities in view of the ongoing coronavirus disease 2019 (COVID-19) pandemic. A total number of 150 statements were selected and graded by Likert scale [from -5 (strongly disagree) to +5 (strongly agree)], starting from six open-ended questions on (i) referral criteria, (ii) optimal timing and setting, (iii) core components, (iv) structure-based metrics, (v) process-based metrics, and (vi) quality indicators. Consensus was reached on 58 (39%) statements, 48 'for' and 10 'against' respectively, mainly in the field of referral, core components, and structure of CR activities, in a comprehensive way suitable for managing cardiac COVID-19 patients. Panelists oriented consensus towards maintaining usual activities on traditional patient groups referred to CR, without significant downgrading of intervention in case of COVID-19 as a comorbidity. Moreover, it has been suggested to consider COVID-19 patients as a referral group to CR per se when the viral disease is complicated by acute cardiovascular (CV) events; in these patients, the potential development of COVID-related CV sequelae, as well as of pulmonary arterial hypertension, needs to be focused. This framework might be used to orient organization and operational of CR programmes during the COVID-19 crisis.

Information about secondary prevention in coronary patients: a comparison between Italian and Brazilian application of MICRO-Q questionnaire.

BACKGROUND: The MICRO-Q (Maugerl CaRdiac preventiOn Questionnaire) is a self-administered questionnaire addressed to the evaluation of information regarding secondary prevention in patients with coronary heart disease (CHD). The aim of this study was to compare the results from Italian and Brazilian application of MICRO-Q. METHODS: the instrument was administered to 500 coronary patients (250 Italian and 250 Brazilian), 117 female and 383 male, aged on average 61.16 years (SD = 9.74; range: 33-86), participants of cardiac rehabilitation programs. The Italian MICRO-Q has 26 items, 18 true statements and 8 false, with responses true, false and 'don't know', with three separate scores: correct, uncorrect and uncertain. The Brazilian MICRO-Q has 25 items, 18 true statements and 7 false, with the same responses and scores. To verify and compare results we used Independent-Sample T Test, ANOVA and Bonferroni Post-hoc. RESULTS: The analysis of mean total scores of Italian and Brazilian applications showed statistically significant differences for correct answers (p < 0.001) and for 'don't know' answers (p < 0.001). 18 statements had significant (p < 0.005) differences between applications in the two countries. CONCLUSION: Despite differences between Italy and Brazil, the analysis of MICRO-Q applications showed a similar mean score percent of correct answers, indicating enough knowledge about secondary prevention of CHD.

Psychosocial Cardiological Schedule-Revised (PCS-R) in a Cardiac Rehabilitation Unit: Reflections Upon Data Collection (2010-2017) and New Challenges.

INTRODUCTION: The Psychosocial Cardiological Schedule (PCS) was developed as a screening tool for patients undergoing cardiac rehabilitation (CR) to detect clinically relevant psychosocial/cognitive problems requiring psychological assessment/intervention. Filled out by a trained nurse, it classifies patients according to their need or not for a psychological interview and intervention provided by the psychologist (PCS-Yes vs. PCS-No). AIMS: The main aim was to compare PCS data collected, respectively, in 2010 and 2017, regarding patients' socio-demographic characteristics, clinical variables, and the inclusion criteria for psychological counseling. Subsequently, the original Italian PCS was revised and an English version of the schedule was provided [PCS-Revised (PCS-R)]. RESULTS: 28 patients (aged 53.5 + 12.6 years, M = 20) of the 87 recruited in 2010 vs. 35 (aged 64.9 + 12.7 years, M = 28) of the 83 recruited in 2017 met the criteria for PCS-Yes: age < 55 years, social problems (living alone, no social support), manifest psychological/behavioral problems, suspected neuropsychological disorders, low prescription adherence, inadequate disease awareness. Comparing the two samples (2010 vs. 2017), clinical variables were similar, and the need for a psychological interview did not differ substantially (32.2 vs. 42.2%), but age increased significantly (PCS-Yes: 53.5 ± 12.6 vs. 64.9 ± 12.7 years, p = 0.001; PCS-No: 68.3 ± 8.0 vs. 75.0 ± 7.7 years, p = 0.0001). A significant increase was observed in the recommendation for neuropsychological assessment (3.6 vs. 25.7%, p = 0.02) to confirm eventual cognitive deficits. These results, the clinical experience, and the recent evidences from literature led to the PCS-R, incorporating a psychosocial screening, a psychological/neuropsychological deeper assessment, and a recommendation for a specific intervention to be carried out either during rehabilitation or in outpatient services. CONCLUSION: The data comparison highlight changes in the cardiac population, which is aging and more frequently requires neuropsychological assessment. The PCS-R could be considered in clinical practice as a useful screening tool to implement a timely coordinated interdisciplinary intervention, comprehensive of specific and tailored psychotherapeutic techniques.

Psychomotor speed as a predictor of functional status in older chronic heart failure (CHF) patients attending cardiac rehabilitation.

BACKGROUND: The association among psychological, neuropsychological dysfunctions and functional/clinical variables in Chronic Heart Failure (CHF) has been extensively addressed in literature. However, only a few studies investigated those associations in the older population. PURPOSE: To evaluate the psychological/neuropsychological profile of older CHF patients, to explore the interrelation with clinical/functional variables and to identify potential independent predictors of patients' functional status. METHODS: This study was conducted with a multi-center observational design. The following assessments were performed: anxiety (Hospital Anxiety and Depression Scale, HADS), depression (Geriatric Depression Scale, GDS), cognitive impairment (Addenbrooke's Cognitive Examination Revised, ACE-R), executive functions (Frontal Assessment Battery, FAB), constructive abilities (Clock Drawing Test, CDT), psychomotor speed and alternated attention (Trail Making Test, TMT-A/B), functional status (6-minute walking test, 6MWT) and clinical variables (New York Heart Association, NYHA; Brain Natriuretic Peptide, BNP; left ventricular ejection fraction, LVEF; left ventricular end diastolic diameter, LVEDD; left ventricular end diastolic volume, LVEDV; tricuspid annular plane systolic excursion, TAPSE). RESULTS: 100 CHF patients (mean age: 74.9±7.1 years; mean LVEF: 36.1±13.4) were included in the study. Anxious and depressive symptoms were observed in 16% and 24,5% of patients, respectively. Age was related to TMT-A and CDT (r = 0.49, p<0.001 and r = -0.32, p = 0.001, respectively), Log-BNP was related to ACE-R-Fluency subtest, (r = -0.22, p = 0.034), and 6MWT was related to ACE-R-Memory subtest and TMT-A (r = 0.24, p = 0.031 and r = -0.32, p = 0.005, respectively). Both anxiety and depression symptoms were related to ACE-R-Total score (r = -0.25, p = 0.013 and r = -0.32, p = 0.002, respectively) and depressive symptoms were related to CDT (r = -0.23, p = 0.024). At multiple regression analysis, Log-BNP and TMT-A were significant and independent predictors of functional status: worse findings on Log-BNP and TMT-A were associated with shorter distance walked at the 6MWT. CONCLUSIONS: Psychological and neuropsychological screening, along with the assessment of psychomotor speed (TMT-A), may provide useful information for older CHF patients undergoing cardiac rehabilitation.

The Patient-Professional Interaction Questionnaire (PPIQ) to assess patient centered care from the patient's perspective.

OBJECTIVE: To investigate how patients evaluate the provision of patient-centered care (PCC) by healthcare professionals and psychometrically test a questionnaire to assess it. A tool previously developed for self-assessment of professionals' provision of PCC was adapted into a patient-rated form, named Patient-Professional Interaction Questionnaire (PPIQ). METHODS: A sample of 1139 patients from six hospitals completed the 16-item PPIQ and the questionnaire structure, reliability, susceptibility to social desirability, and associations with other variables were tested. RESULTS: The PPIQ confirmed the original four-factor structure (effective communication, interest in the patient's agenda, empathy, and patient involvement in care) and showed acceptable reliability and measurement invariance across both in-/out-patients and first/non-first encounter with the evaluated professional. Associations with patients' social desirability were negligible and effective communication was rated the highest among the PPIQ dimensions. PPIQ scores varied according to patients' educational level and type of professional evaluated, while associations between first/non-first encounter and PPIQ scores varied according to in-/out-patient. CONCLUSION: The PPIQ is a psychometrically sound patient-rated measure of the provision of PCC by healthcare professionals. PRACTICE IMPLICATIONS: The PPIQ has potential value in promoting quality patient-professional interactions in the hospital setting, as patients' reported experience is an important dimension of the clinician's performance.

Validation of the Health Care Communication Questionnaire (HCCQ) to measure outpatients' experience of communication with hospital staff.

OBJECTIVE: All healthcare workers' communication skills are recognised as valuable indicators of quality of care from the patient's perspective. Most of the studies measure doctor-patient communication, giving scarce attention to other professionals. This study is aimed at developing and providing preliminary validation of a questionnaire to measure outpatients' experience of communication with hospital personnel other than doctors. METHODS: Small groups of outpatients and hospital staffs were involved in identifying the domains and generating the items. A quantitative validation phase involving 401 outpatients followed in order to verify the hypothesised dimensionality of selected items and to measure reliability. RESULTS: A 13-item questionnaire emerged, comprising four components of outpatients' experience in the healthcare communication domain: problem solving, respect, lack of hostility, and nonverbal immediacy. Psychometric tests were promising as regards factorial validity, evaluated with confirmatory factor analysis, and scales reliability. Factor scores were independent of patients' gender, age, and education. CONCLUSION: The developed Health Care Communication Questionnaire (HCCQ) is a self-administered brief measure with good psychometric properties. PRACTICE IMPLICATIONS: The HCCQ gives information that could be taken as an indirect and subjective indicator of the quality of hospital services as provided by non-medical staff. This aspect may have a role in local quality improvement initiatives.

[Organization of psychological activities in Italian cardiac rehabilitation and prevention. Survey on the implementation of guidelines for psychological activities in cardiac rehabilitation and prevention]. / Organizzazione delle attività di psicologia nelle strutture di cardiologia riabilitativa italiane. Indagine conoscitiva sulla implementazione delle linee guida per le attività di psicologia in cardiologia riabilitativa e preventiva.

UNLABELLED: The present study was developed as part of a comprehensive evaluation of the state of the art of knowledge and implementation of the Italian Guidelines for psychological activities in Cardiac Rehabilitation, published in 2003 by the Working Group of Psychology of the Italian Society of Cardiac Rehabilitation (GICR). METHODS: A questionnaire was designed to collect detailed information on facilities, organization, staffing level, professional background and activities carried out by psychologists working in Italian Cardiac Rehabilitation Units (CRU). Out of 144 Italian CRU (inventory 2004), 107 reported structured psychological programmes. The questionnaires were sent by conventional mail to the referring psychologist of these 107 CRU; they were invited to participate in the survey on a purely voluntary basis. RESULTS: Responses were received from 70 (65.4%) of 107 CRU. 55 CRU (79.8%) report a good knowledge of the published GL; 10.1% declare that the psychologists did not know the current GL. 84.5% consider the GL to be fully applicable, while 15.5% believe that they are only partly applicable. Psychological assessment is performed through clinical interview (94.3%) and psychometric tests (81.4%). 92.8% of the CRU use screening instruments in order to evaluate psychosocial risk factors, in particular anxiety and depression (64.3%). Quality of life (22.8%) and cognitive impairment (17.1%) are not routinely assessed. Educational interventions are planned in 87.1% of the CR programme and are extended to the family members (51%) as well as counselling (57%). Psychological programme includes smoking (56%) and eating behaviour (55%) group interventions. Stress management is routinely planned in 69% of the CRU. Psychological intervention tailored to individual needs of the patients is performed in 62.9% CRU. Written final reports are available in 88.6% cases. The follow-up is carried out by 48.6% of the CRU, 15.7% in a structured way. CONCLUSIONS. The survey shows wide discrepancies in the provision of psychological activities in Italian CRU. Nevertheless psychological assessment and interventions seem acceptably coherent with current national GL on CR.

Anxiety and depression in patients with pulmonary hypertension: impact and management challenges.

BACKGROUND: Anxiety and depression are frequent disorders in patients with pulmonary arterial hypertension (PAH), but despite this only less than one-fourth of them is treated. Our aim was to review the studies regarding the prevalence and the impact of anxiety and depression and to propose management challenges. METHODS: A literature review regarding 1) anxiety and depression studies in PAH patients and caregivers, 2) psychological interventions, 3) slow breathing approach, and 4) pharmacological approach was performed, based on evidence of effectiveness through a search of the most well-known databases (Cochrane Library, Medline, PsychINFO [2004-2018]). RESULTS: The prevalence of mental disorders in PAH patients lies between 7.5% and 53% for depression and 19% and 51% for anxiety and panic disorders. The latest guidelines of the European Society of Cardiology recommend a psychological support with a class of recommendation I and a level of evidence c. The analysis of psychological intervention shows that at present there is no evidence of specific psychological interventions in these patients. However, treatment approaches based on other chronic illnesses are suggested, especially based on relaxation training, slow breathing, and cognitive behavioral therapy. Finally, data concerning the use of antidepressant drugs are conflicting. CONCLUSION: Firstly, our data demonstrate a common underestimation of mental disorders by health professionals and secondly, the need of implementing appropriate methods of screening for mental disorders in PAH patients. However, the paucity of large observational studies in this area requires the attention of researchers. The evidence about optimal approaches for managing anxiety and depression in PAH also remains unclear and largely speculative. The challenge is the introduction of routine psychological intervention, as suggested by the European Society of Cardiology and already applied in other chronic disease.

Screening for neuropsychological impairment in COPD patients undergoing rehabilitation.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a complex multi-component disorder characterized by progressive irreversible respiratory symptoms and extrapulmonary comorbidities, including anxiety-depression and mild cognitive impairment (MCI). However, the prevalence of these impairments is still uncertain, due to non-optimal screening methods. This observational cross-sectional multicentre study aimed to evaluate the prevalence of anxiety-depressive symptoms and MCI in COPD patients, identify the most appropriate cognitive tests to screen MCI, and investigate specific cognitive deficits in these patients and possible predictive factors. MATERIALS AND METHODS: Sixty-five stable COPD inpatients (n = 65, aged 69.9±7.6 years, mainly stage III-IV GOLD) underwent the following assessments: Hospital Anxiety and Depression Scale (HADS), Geriatric Depression Scale (GDS) or Beck Depression Inventory-II (BDI-II), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and a complete neuropsychological battery (ENB-2) including different cognitive domains (attention, memory, executive functions, and perceptive and praxis abilities). RESULTS: Moderate-severe anxiety was present in 18.5% of patients and depressive symptoms in 30.7%. The prevalence of MCI varied according to the test: 6.2% (MMSE), 18.5% (MoCA) and 50.8% (ENB-2). In ENB-2, patients performed significantly worse compared to Italian normative data on digit span (5.11±0.9 vs. 5.52±1.0, p = 0.0004), trail making test-B (TMT-B) (176.31±99.5 vs. 135.93±58.0, p = 0.004), overlapping pictures (26.03±8.9 vs. 28.75±8.2, p = 0.018) and copy drawing (1.370.6 vs. 1.61±0.5, p = 0.002). At logistic regression analysis, only COPD severity (p = 0.012, odds ratio, OR, 4.4 [95% CI: 1.4-14.0]) and anxiety symptoms (p = 0.026, OR 4.6 [1.2-17.7]) were significant and independent predictors of the deficit in copy drawing, which assesses visuospatial and praxis skills. CONCLUSION: Given the prevalence of neuropsychological impairments in COPD patients, the routine adoption in rehabilitation of screening tools for mood and cognitive function, including digit span, TMT-B and copy drawing, may be useful to detect psychosocial comorbidities and personalize the rehabilitative program.

What constitutes the 'Minimal Care' interventions of the nurse, physiotherapist, dietician and psychologist in Cardiovascular Rehabilitation and secondary prevention: A position paper from the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology.

BACKGROUND: In cardiovascular prevention and rehabilitation, care activities are carried out by different professionals in coordination, each with their own specific competence. This GICR-IACPR position paper has analysed the interventions performed by the nurse, physiotherapist, dietician and psychologist in order to identify what constitutes minimal care, and it lists the activities that are fundamental and indispensable for each team member to perform in clinical practice. RESULTS: In analysing each type of intervention, the following dimensions were considered: the level of clinical care complexity, determined both by the disease and by environmental factors; the 'area' complexity, i.e. the specific level of competence required of the professional in each professional section; organisational factors, i.e. whether the care is performed in an inpatient or outpatient setting; duration of the rehabilitation intervention. The specific contents of minimal care have been identified for each professional area together with the specific goals, the assessment tools and the main essential interventions. For the assessments, only a few validated tools have been indicated, leaving the choice of which instrument to use to the individual professional based on experience and usual practice. CONCLUSION: For the interventions, attention has been focused on conditions of major complexity requiring special care, taking into account the different care settings, the clinical conditions secondary to the disease event, and the distinct tasks of each area according to the operator's specific role. The final report performed by each professional has also been included.

Self-perceived provision of patient centered care by healthcare professionals: The role of emotional intelligence and general self-efficacy.

OBJECTIVE: This study aimed to investigate whether healthcare professionals' emotional intelligence (EI) is associated with self-perceived provision of patient-centered care (PCC), taking into account the potential mediating effect of general self-efficacy (GSE). METHODS: A sample of 318 healthcare professionals, recruited in 2015 among four hospitals in Italy, completed the Provider-Patient Relationship Questionnaire, the Emotional Intelligence Scale, and the General Self-Efficacy scale. A structural equation model was tested with GSE mediating the relationship between EI and self-perceived provision of PCC. Groups of participants based on gender, profession, and work setting were also compared on the study variables. RESULTS: EI had direct effects on the self-perceived provision of PCC dimensions. GSE partially mediated only the relationship between EI and involving the patient in care. Healthcare professionals in rehabilitation units showed higher self-perceived provision of PCC than those in acute care or ambulatory services. CONCLUSION: Self-perceived provision of PCC seems to have the potential to be improved by EI and to be distinguishable from GSE. PRACTICE IMPLICATIONS: Since EI can be developed, findings of this study have potential implications for improving PCC through continuing education interventions for healthcare professionals.