The Contribution of Psychosocial Interventions to Precision Medicine for Heart Health

doi:10.1016/j.pcad.2018.12.005

Progress in Cardiovascular Diseases

Volume 62, Issue 1, January–February 2019, Pages 21-28

https://doi.org/10.1016/j.pcad.2018.12.005 Get rights and content

Abstract

This paper reviews the value of incorporating psychosocial interventions into precision medicine for heart health. First, we review the empirical literature on prevalence of common mental health comorbidities among individuals with cardiovascular disease (CVD). We then review transdiagnostic approaches for conceptualization and treatment of mental health in individuals with CVD. We highlight recent studies that have used novel methods to individualize psychosocial interventions. Finally, we propose a preliminary framework intended to support Health Care Providers in individualizing treatment, which includes: 1) assessment of patient risk factors, characteristics, and expectations; 2) consideration of transdiagnostic processes underlying several psychiatric symptoms that contribute to CVD risk; 3) patient engagement in shared decision-making for psychosocial treatment; and 4) ongoing outcome monitoring to evaluate treatment responsiveness. We anticipate that the proposed framework will evolve with the emergence of new empirical evidence; as such, future directions and challenges for research are discussed.

Section snippets

CVD and common comorbid mental health challenges

There is opportunity for integrating precision medicine and psychological intervention principles in the prevention and treatment of CVD. Research has consistently reported an association between poor mental health and increased risk of CVD. For example, the authors of a recent study of 524,952 patients registered in 140 primary care practices in the UK reported that individuals with psychiatric disorders (i.e., schizophrenia, bipolar, depression, anxiety, and personality disorders) have an

A precision medicine framework for psychosocial care in heart health

HCPs are expected to maintain familiarity with an ever-increasing scope of practice guidelines for one-size-fits-all approaches to treatment. It is cause for concern that HCPs could become overwhelmed by advances in precision medicine, which will require retention and integration of increasingly complex clinical decision-making algorithms. An efficient implementation framework for best-practice in precision medicine is especially important given that provider adherence to clinical guidelines is

Conclusions

The overlapping symptomatology in depression, anxiety and stress-related disorders, which commonly co-occur with CVD, points to the need for considering transdiagnostic factors during assessment and treatment. Key ingredients to consider when adopting a precision medicine framework for treating these conditions in cardiac patients include understanding patient preferences and expectations, engaging in collaborative consultation practice with patients, knowledge of stepped care models, and

References (61)

M. Pérez-Piñar et al.
Cardiovascular risk factors among patients with schizophrenia, bipolar, depressive, anxiety, and personality disorders
Eur Psychiatry
(2016)
A. Meijer et al.
Prognostic association of depression following MI with mortality and cardiovascular events: a meta-analysis of 25 years of research
Gen Hosp Psychiatry
(2011)
A.M. Roest et al.
Anxiety and risk of incident coronary heart disease: a meta-analysis
J Am Coll Cardiol
(2010)
A. Seldenrijk et al.
Depression, anxiety and 6-year risk of cardiovascular disease
J Psychosom Res
(2015)
F. Bonnet et al.
Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease
Atherosclerosis
(2005)
M. Bäck et al.
The impact on kinesiophobia (fear of movement) by clinical variables for patients with coronary artery disease
Int J Cardiol
(2013)
K. Ginzburg et al.
Posttraumatic stress syndromes and health-related quality of life following MI: 8-year follow-up
Gen Hosp Psychiatry
(2011)
D. Edmondson et al.
Posttraumatic stress disorder and cardiovascular disease
Prog Cardiovasc Dis
(2013)
D. Edmondson et al.
Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality
J Psychiatr Res
(2011)
M.-A. Roberge et al.
Post-traumatic stress disorder following MI: prevalence and risk factors
Can J Cardiol
(2010)

M.L. Woody et al.

Integrating NIMH research domain criteria (RDoC) into depression research

Curr Opin Psychol

(2015)

A. Reinecke et al.

Predicting rapid response to cognitive-behavioural treatment for panic disorder: the role of hippocampus, insula, and dorsolateral prefrontal cortex

Behav Res Ther

(2014)

C.H. Fu et al.

Predictive neural biomarkers of clinical response in depression: a meta-analysis of functional and structural neuroimaging studies of pharmacological and psychological therapies

Neurobiol Dis

(2013)

D. Richards

Prevalence and clinical course of depression: a review

Clin Psychol Rev

(2011)

L.M. Williams et al.

The ENGAGE study: integrating neuroimaging, virtual reality and smartphone sensing to understand self-regulation for managing depression and obesity in a precision medicine model

Behav Res Ther

(2018)

National Institutes of Health

What is precision medicine?

C.U. Correll et al.

Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls

World Psychiatry

(2017)

American Psychiatric Association

Diagnostic and statistical manual of mental disorders (DSM-5®)

(2013)

C.M. Celano et al.

Depression and cardiac disease: a review

Cardiol Rev

(2011)

R.M. Carney et al.

Depression and coronary heart disease

Nat Rev Cardiol

(2017)

N. Frasure-Smith et al.

Reflections on depression as a cardiac risk factor

Psychosom Med

(2005)

I.M. Kronish et al.

Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes

J Gen Intern Med

(2006)

N.M. Batelaan et al.

Anxiety and new onset of cardiovascular disease: critical review and meta-analysis

Br J Psychiatry

(2016)

S.L. Grace et al.

Prospective examination of anxiety persistence and its relationship to cardiac symptoms and recurrent cardiac events

Psychother Psychosom

(2004)

H.-P. Feng et al.

Risk of anxiety and depressive disorders in patients with MI: a nationwide population-based cohort study

Medicine

(2016)

B.E. Cohen et al.

State of the art review: depression, stress, anxiety, and cardiovascular disease

Am J Hypertens

(2015)

K. Ginzburg et al.

Trajectories of posttraumatic stress disorder following MI: a prospective study

J Clin Psychiatry

(2003)

K. Ginzburg et al.

Acute stress disorder symptoms predict all-cause mortality among MI patients: a 15-year longitudinal study

Ann Behav Med

(2015)

S.S. Coughlin

Post-traumatic stress disorder and cardiovascular disease

Open Cardiovasc Med J

(2011)

A. Wikman et al.

Persistence of posttraumatic stress symptoms 12 and 36 months after acute coronary syndrome

Psychosom Med

(2008)

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Citation Excerpt :
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^☆: Disclosures: None.

^☆☆: Conflict of interest: None.

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The Contribution of Psychosocial Interventions to Precision Medicine for Heart Health☆,☆☆

Abstract

Section snippets

CVD and common comorbid mental health challenges

A precision medicine framework for psychosocial care in heart health

Conclusions

Eur Psychiatry

Gen Hosp Psychiatry

J Am Coll Cardiol

J Psychosom Res

Atherosclerosis

Int J Cardiol

Gen Hosp Psychiatry

Prog Cardiovasc Dis

J Psychiatr Res

Can J Cardiol

Curr Opin Psychol

Behav Res Ther

Neurobiol Dis

Clin Psychol Rev

Behav Res Ther

What is precision medicine?

Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls

World Psychiatry

Diagnostic and statistical manual of mental disorders (DSM-5®)

Depression and cardiac disease: a review

Cardiol Rev

Depression and coronary heart disease

Nat Rev Cardiol

Reflections on depression as a cardiac risk factor

Psychosom Med

Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes

J Gen Intern Med

Anxiety and new onset of cardiovascular disease: critical review and meta-analysis

Br J Psychiatry

Prospective examination of anxiety persistence and its relationship to cardiac symptoms and recurrent cardiac events

Psychother Psychosom

Risk of anxiety and depressive disorders in patients with MI: a nationwide population-based cohort study

Medicine

State of the art review: depression, stress, anxiety, and cardiovascular disease

Am J Hypertens

Trajectories of posttraumatic stress disorder following MI: a prospective study

J Clin Psychiatry

Acute stress disorder symptoms predict all-cause mortality among MI patients: a 15-year longitudinal study

Ann Behav Med

Post-traumatic stress disorder and cardiovascular disease

Open Cardiovasc Med J

Persistence of posttraumatic stress symptoms 12 and 36 months after acute coronary syndrome

Psychosom Med

Persistence of posttraumatic stress symptoms 12 and 36 months after acute coronary syndrome