The psychological consequences of living with coronary heart disease: Are patients' psychological needs served? A mixed-method study in Germany.

INTRODUCTION: This mixed-method study explores psychological needs, access and barriers in coronary heart disease (CHD) patients with and without mental health issues (MHI) within the German healthcare system. METHODS: This study was conducted in three different healthcare settings: two hospitals, two rehabilitation clinics and three cardiology practices in Cologne, Germany. Patients were screened for angiographically documented CHD and other inclusion criteria. In total, 364 CHD patients took part in this study. It consisted of two parts: In the first part, participants filled in a newly developed questionnaire about their psychological needs, access and barriers within the healthcare system and their contact with their doctor in these matters. Then, patients were screened for MHIs with the help of the Hospital Anxiety and Depression Scale (HADS). When a score above seven was scored on the HADS, patients were additionally screened for specific MHIs using the Structured Clinical Interview for DSM-IV Axis I Disorders. In the second part, 20 participants were subsequently interviewed in a semi-structured interview to generate more in-depth findings. RESULTS: The interviews show that CHD patients with and without MHI experienced a cardiac event as life-changing and had an urgent need to talk about CHD with their doctor, mostly the general practitioner (GP). When the GP spoke to the patient shortly after the cardiac event, patients experienced relief and were better able to cope with their illness. Only 9.1% reported being aided in their search for psychotherapeutic treatment or drug treatment (4.1%). CONCLUSION: The needs of CHD patients with and without MHI were not adequately satisfied within our sample. Psychological measures are necessary for sufficient improvement, such as training of doctors in doctor-patient communication (e.g., better support in coping with MHI/CHD), improvements in the procedure (more time for conversations during doctor contacts), and improvement of structural requirements (referring patients faster to psychotherapists). PATIENT OR PUBLIC CONTRIBUTION: We received input from patients during pretests and used the feedback to tailor our questionnaire and the interview guidelines. Afterwards, we disseminated the main results for the patient and public involvement (e.g., public lectures, leaflets for self-help groups, etc.).

Detection and treatment of mental disorders in patients with coronary heart disease (MenDis-CHD): A cross-sectional study.

Mental disorders (MD) are associated with an increased risk of developing coronary heart disease (CHD) and with higher CHD-related morbidity and mortality. There is a strong recommendation to routinely screen CHD patients for MDs, diagnosis, and treatment by recent guidelines. The current study aimed at mapping CHD patients' (1) state of diagnostics and, if necessary, treatment of MDs, (2) trajectories and detection rate in healthcare, and (3) the influence of MDs and its management on quality of life and patient satisfaction. The design was a cross-sectional study in three settings (two hospitals, two rehabilitation clinics, three cardiology practices). CHD patients were screened for MDs with the Hospital Anxiety and Depression Scale (HADS), and, if screened-positive, examined for MDs with the Structured Clinical Interview for DSM-IV (SCID-I). Quality of Life (EQ-5D), Patient Assessment of Care for Chronic Conditions (PACIC), and previous routine diagnostics and treatment for MDs were examined. Descriptive statistics, Chi-squared tests, and ANOVA were used for analyses. Analyses of the data of 364 patients resulted in 33.8% positive HADS-screenings and 28.0% SCID-I diagnoses. The detection rate of correctly pre-diagnosed MDs was 49.0%. Physicians actively approached approximately thirty percent of patients on MDs; however, only 6.6% of patients underwent psychotherapy and 4.1% medication therapy through psychotherapists/psychiatrists. MD patients scored significantly lower on EQ-5D and the PACIC. The state of diagnostic and treatment of comorbid MDs in patients with CHD is insufficient. Patients showed a positive attitude towards addressing MDs and were satisfied with medical treatment, but less with MD-related advice. Physicians in secondary care need more training inadequately addressing mental comorbidity.

Quality of health care with regard to detection and treatment of mental disorders in patients with coronary heart disease (MenDis-CHD): study protocol.

BACKGROUND: Mental disorders (MD), such as depression, anxiety, and cognitive impairment, are highly prevalent in patients with coronary heart disease (CHD). Current guidelines on cardiovascular diseases recommend screening and appropriate treatment of MD; however, the degree of implementation of such recommendations in clinical practice is unknown. This study aims to analyze the quality of health care of patients with CHD and MD. Specifically, we aim to analyze (1) the quality of care, (2) trajectories of care, and (3) barriers regarding the detection and treatment of MD. Moreover, we want to identify potentials of changes in health care delivery towards more patient-centered care. The results of this study shall be the first step towards value-based care of people with CHD and comorbid mental disorders. METHODS: We aim to include the following participants: adult patients with CHD (n = 400), their relatives (n = 350) and physicians (n = 80). A particular focus will be on the vulnerable subgroups of patients with CHD and congestive heart failure (left ventricular ejection fraction < 40%) and on the underrepresented group of women with CHD. We will apply a mixed-method approach with a quantitative and a qualitative part. Patient-related outcomes (e.g., health-related quality of life, needs, and preferences regarding health care, reasons for non-detection, and lack of treatment of MD) will be explored in a multi-perspective approach including patients, relatives, and physicians' perspectives. Furthermore, routine data from four statutory health insurance funds (SHI) will be analyzed regarding the frequency and treatment of MD in CHD patients. DISCUSSION: MenDis-CHD will provide important insights into the trajectories of health care, quality of health care, barriers, patient needs and preferences as well as expectations and satisfaction with health care in patients with CHD and MD. Potential implications of MenDis-CHD are to enable health care providers to redesign care pathways concerning the treatment of mental comorbidity in patients with CHD by proposing value-based changes in health care and by understanding the barriers to and facilitators of change towards patient-centered care. TRIALS REGISTRATION: German clinical trials register (Deutsches Register Klinischer Studien, DRKS) ieRegistration Number: DRKS00012434, date of registration: May 11th, 2017.