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Heart and mind: behavioural cardiology demystified for the clinician
  1. Felicity Astin1,2,
  2. Mike Lucock1,
  3. Catriona S Jennings3
  1. 1 Centre for Applied Research in Health, University of Huddersfield, Huddersfield, West Yorkshire, UK
  2. 2 Calderdale & Huddersfield NHS Foundation Trust, Research and Development Department, Huddersfield, West Yorkshire, UK
  3. 3 National Heart & Lung Institute, Imperial College London, London, UK
  1. Correspondence to Dr Catriona S Jennings, NHLI, Imperial College London, London SW7 2AZ, UK; c.jennings{at}imperial.ac.uk

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Learning objectives

  • Define ‘behavioural cardiology’

  • Describe key psychological and social risk factors for cardiovascular disease and recognise their impact on behaviour change and the ability to self-manage health

  • Identify communication skills, behaviour change techniques and psychological interventions that can be applied to optimise cardiovascular prevention and rehabilitation

Clinical scenario

Dr Stratin is sitting in a clinic with Mr B, a 45-year-old man who had an anterior ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention 6 weeks ago. He felt ‘fixed’ by his treatment and was shocked but relieved to be discharged home after 3 days. He lives alone and has returned to his work as a self-employed builder. Mr B has continued to smoke after his acute myocardial infarction. He is also anxious about his risk of future recurrence and has had to question his assumptions about his physical health and expectations about his health in future years. He is obese and not undertaking any structured exercise. His blood pressure is elevated and he admits that the way in which he takes his cardioprotective medication is a ‘bit hit and miss’.

This clinical scenario illustrates common psychosocial factors that can impact negatively on a patient’s recovery and clinical outcomes following treatment for STEMI. These factors will be described and strategies that can be applied to Mr B’ care summarised.

Introduction

Behavioural cardiology is defined as ‘the study and application of psychosocial factors in the assessment and reduction of cardiovascular risk’.1 Over the last 15 years, there has been a growing recognition that psychosocial risk factors make a significant contribution to the atherosclerotic process leading to cardiovascular disease (CVD) through biological and behavioural mechanisms.2 It is recognised that psychosocial risk factors, such as depression and social isolation, are as potent as many biological and behavioural coronary risk factors. In this paper, we will …

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