Introduction

Despite growing recognition of the impact of psychosocial factors on cardiovascular disease (CVD), as exemplified in recent guidelines from the European Society of Cardiology1 and a Scientific Statement from the American Heart Association,2 they do not receive the same degree of attention as other aspects of preventive cardiology, such as physical activity. Yet, psychosocial factors, such as depression and anxiety, adversely influence adherence to medication and act as barriers to behaviour change and also adversely affect the health and well-being of patients, their partners, families and caregivers. If, for example, depression is not addressed, it may have negative consequences for the patient and healthcare system, including poorer patient health outcomes, quality of life and well-being, incomplete or failed return to work and attenuation of healthcare costs.3–5

Depression and anxiety are common among people with CVD: 30% of women and 20% of men report clinically relevant symptoms of depression; 39% of women and 22% of men report clinically relevant symptoms of anxiety.6 The prevalence of depression and anxiety is higher in CVD populations than in the general population.4 In some CVD populations, for example, with an implantable cardioverter defibrillator (ICD), over 50% meet the criteria for anxiety.7 Depression and anxiety are associated with being female, having a lower level of educational attainment, a sedentary or inactive lifestyle, more severe symptoms, poorer quality of life, increased risk of disease and death and increased healthcare costs.6 8 Moreover, as CVD and depression are the most common causes of disability in high income countries and predicted to remain among the top 10 of diseases worldwide until …