Collaborative Care and Related Interventions in Patients With Heart Disease: An Update and New Directions.

BACKGROUND: Psychiatric disorders, such as depression, are very common in cardiac patients and are independently linked to adverse cardiac outcomes, including mortality. Collaborative care and other integrated care models have been used successfully to manage psychiatric conditions in patients with heart disease, with beneficial effects on function and other outcomes. Novel programs using remote delivery of mental health interventions and promotion of psychological well-being may play an increasingly large role in supporting cardiovascular health. METHODS: We review prior studies of standard and expanded integrated care programs among patients with cardiac disease, examine contemporary intervention delivery methods (e.g., Internet or mobile phone) that could be adapted for these programs, and outline mental health-related interventions to promote healthy behaviors and overall recovery across all cardiac patients. RESULTS: Standard integrated care models for mental health disorders are effective at improving mood, anxiety, and function in patients with heart disease. Novel, "blended" collaborative care models may have even greater promise in improving cardiac outcomes, and interfacing with cardiac patients via mobile applications, text messages, and video visits may provide additional benefit. A variety of newer interventions using stress management, mindfulness, or positive psychology have shown promising effects on mental health, health behaviors, and overall cardiac outcomes. CONCLUSIONS: Further study of novel applications of collaborative care and related interventions is warranted given the potential of these programs to increase the reach and effect of mental health interventions in patients with heart disease.

A randomized trial of an optimism training intervention in patients with heart disease.

OBJECTIVE: Optimism is prospectively and independently associated with superior cardiac outcomes, but there has been minimal study of optimism-specific interventions in persons with cardiovascular illness. We aimed to examine the feasibility and impact of an optimism-promoting program among patients with heart disease in a randomized controlled trial. METHODS: Participants (N=61) were outpatients, age 35-60, with coronary artery disease who were randomized to an 8-week in-person group-based optimism training intervention or an attention-matched educational control condition. Feasibility was assessed via rates of session attendance and exercise completion, and acceptability was assessed via weekly participant ratings of exercise ease, utility, and likelihood of continuation. The impact of the intervention was assessed via between-group differences in change from baseline optimism (Life Orientation Test-Revised [LOT-R]) and other psychological self-report outcomes at 8weeks (primary time point) and 16weeks, using random effects regression models. RESULTS: Participants completed a mean of 6.8 (SD 1.2) sessions and 13.9 (SD 2.4) exercises, with mean ratings all >3.5/5 on measures of acceptability. The intervention was associated with greater improvement in optimism at 8weeks (ß=5.13; 95% confidence interval [CI]=3.55, 6.70; p<0.001) and 16weeks; the intervention was also associated with greater improvements in life satisfaction, hope, and anxiety at both time points, though not with positive or negative affect. CONCLUSIONS: A group-based optimism training program was feasible, acceptable, and associated with improvements in optimism and other psychological measures in cardiac patients. Future larger studies should examine effects on major clinical outcomes.