Position Paper On The Relevance Of Psychosocial Factors In Cardiology

Background. Growing evidence of an interaction between psychosocial factors and the onset and disease progression of a variety of cardiac disease conditions has prompted the Clinical Commission of the German Heart Society (DGK) to propose a state-of-the-art paper on this issue.Methods. In a formalised rating procedure, a task force of ten experts in the field identified sub-areas of major interest stratified for aetiological/prognostic factors and intervention/therapy. Evidence was pooled, and recommendations were issued based on the strength of empirical evidence.Findings. In general, evidence of the predictive power of aetiological and prognostic psychosocial factors is currently stronger than for positive health outcomes following psychosocial interventions. Co-morbid psychosocial and affective parameters in the context of coronary heart disease (CHD) received most attention, with an IA recommendation for depression screening as an aetiological and prognostic risk factor, for the need to implement behavioural concepts in prevention strategies to improve delay time to hospital admission at disease onset, and for the need to routinely integrate psychosocial interventions in the disease management of CHD patients. An additional IA recommendation was given for including psychological stress factors in the evaluation of treatment progress in ICD patients. Further areas of interest deal with quality of life in patients with heart failure and interventions for patients following cardiac surgery.Conclusions. The present state-of-the-art paper has succeeded in translating current empirical evidence from behavioural science into evidence-based recommendations for the integration of psychosocial factors into cardiology practice and in formulating areas of high priority. The evidence for estimating the efficiency of psycho-therapeutic interventions in cardiac patients is still weak. There is an urgent need to establish curricula for physician competence in psycho-diagnosis, communication and referral to ensure that current psycho-cardiac knowledge can be applied in everyday practice.