ReviewPsychological treatments in cardiac rehabilitation: review of rationales and outcomes
Introduction
This review article focuses on psychosocial interventions offered to cardiac patients in support of their rehabilitation. For many health care providers, cardiac rehabilitation is synonymous with exercise-based rehabilitation and this is likely due to the fact that, in attempts to maximize the gains achieved with surgery and drug regimens, exercise rehabilitation was typically the first component added to standard medical care. More recently, cardiac rehabilitation programs have added comprehensive dietary education and psychosocial support 1, 2. Most published evaluations of cardiac rehabilitation effectively describe the outcomes of multicomponent programs, and the evaluation of individual component outcomes is essentially impossible with these protocols. The purpose of this review, therefore, is to focus on psychological interventions and on the added benefit that they can provide. The reader interested in a broader review of cardiac rehabilitation is referred elsewhere [1].
Section snippets
Modes and targets for intervention
Obviously, heart disease is not a primary psychological pathology, although psychological factors play an important role in the recovery from a major cardiac event and may, in fact, have contributed to it in the first place. The rehabilitation process varies greatly from one patient to another [3], and this is accentuated by differences in severity of underlying disease and type of medical intervention received. A first myocardial infarction hits many patients unprepared, whereas bypass surgery
Outcomes
There have been many published reviews of the outcome of cardiac rehabilitation programs and re-reviewing all of them in detail would be redundant. Analyzing these reviews, however, has revealed some interesting and meaningful trends over time. The early reviews were typically narrative in nature; later on, statistical meta-analyses were added to the literature and, as will be shown in what follows, they contributed greatly to solidifying conclusions and recommendations.
Conclusion
Aside from the emerging arena of managing chronic heart failure, there appear to be a number of important conclusions that may guide clinicians and researchers in guiding their next steps in psychosocial cardiac rehabilitation. There also remain many open-ended, crucial questions on the research agenda.
What do we know? Psychosocial interventions, when added to other active rehabilitation conditions, can improve the odds for mortality and for nonfatal MI recurrence, but this may not apply to
Acknowledgements
During the preparation of this article the author was financially supported by grants from the Medical Research Council, the BC and Yukon Heart and Stroke Foundation, and the Social Sciences and Humanities Research Council of Canada. Appreciation is expressed to Dr. Nancy Frasure-Smith and two anonymous reviewers who provided valuable feedback on an earlier draft of the manuscript.
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