Netherlands Heart Foundation

The psychological impact of a T'I cardiovascular disease Cardiovascular diseases have a number of consequences for the patient's psychological well-being and social life. The diagnosis of a cardiovascular disease can be a fearful event for many patients. In particular, patients with heart failure suffer more from anxiety and depression than other cardiac patients Given the impact ofpsychological factors on the development and progress of the disease, it is essential to offer cardiac patients psychological help along with medical care. Cardiac rehabilitation focuses on optimising both the phsi cal function and the psychological well-being.' Psychosocial supervision should form an integral part of standard care.2 In the current healthcare system, consideration is given to the psychosocial aspects of care at various stages in the healthcare chain, but this attention is not applied consistently. In particular, no attention is given to the dynamic course of the psychosocial issues as the disease progresses over time. The Netherlands Heart Foundation has initiated the Coping with Cardiovascular Disease programme. The aim of the programme is to create a coordinated approach to the psychosocial consequences of cardiovascular diseases to optimise the quality of life of patients in the acute, rehabilitation and chronic phases of the disease. The relationship between emotions and cardiovascular disease Evidence continues to accumulate showing that negative feelings are not only associated with a reduction in well-being and the quality of life a patient experiences, but that having negative feelings is also related to a much higher risk of a recurrence of a cardiac event, independent of the standard cardiac risk factors. This particularly applies to those patients who often have negative feelings and concurrently feel restricted in social interactions, and keep these feelings to

themselves.3 In addition, there is scientific evidence that relaxation therapy contributes positively to the effect of the cardiac rehabilitation programme.4 Comprehensive rehabilitation is clearly associated with a reduction in the negative feelings the patients experience and with a reduction in mortality.' Furthermore, it appears that people with a somatic chronic disease draw different conclusions about the adaptive problems associated with the disease than their family physicians. To estimate the extent ofthe need for care and support, the doctor will have to explicitly discuss these needs with the patient.2

As part of the programme, the Netherlands Heart Foundation has organised three symposia, from three different perspectives: thus, we combine the expertise of scientific researchers and the know-how of caregivers (psychologists, social workers and nurses) with the perspective of patients and partners who are confronted with the outcomes of cardiovascular diseases in everyday life. By combining these three perspectives, a link is formed between theory and practice. Based on the symposium series, the report Living with change was published, in which a description is given of how the adjustment process evolves over time and what problems the patient is likely to experience during this process.6 During this adjustment process the patient tries to achieve various goals. Initially, the focus is on minimising the outcomes of the disease. Physical reconditioning and providing information about risk factors and lifestyle modifications are components of this. However, often not all the outcomes of the disease can be alleviated, and the patient is confronted with permanent limitations. This requires the patient to take another approach: if the situation cannot be changed, the patient will have to adjust to the situation. Information about the process of adjustment and solution-focused therapy are possible interventions that can support the patient in this process. The proposed model allows caregivers to couple specific psychosocial interventions to the different stages of the adjustment process. In this way, a wide range of care activities and interventions can be systematically organised. In highquality cardiological care, it is essential to offer the proper intervention at the right moment in psychosocial terms as well. l Dr. Peter Donders, psychologist Netherlands Heart Foundation References 1 2

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The Coping with Cardiovascular Disease programme With this programme the Netherlands Heart Foundation is striving to produce a coordinated approach to the psychological consequences of cardiovascular disease.

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Verwaal I, van der Voort P, Denollet J. Cardiovasculaire aandoeningen. In: Pool G, Heuvel F, Rachor AV, Sanderman R (eds.). Handboek Psychologische interventies bij chronisch-somatische aandoeningen. Assen: 2004. Rijken PM, Heijmans MJWM, Bensing JM. Adaptieve opgaven als uitgangspunt voor de psychosociale zorg voor somatisch chronisch zieken. In: Groenewegen PP, van den Bos GAM, van Mechelen PJ. Zorg, opvang en begeleiding van chronisch zieken. Assen: 2004. Pedersen SS, Denollet J. Type D personality, cardiac events, and impaired quality oflife: a review. EurJCardiovascPrev Rehabil2003;10(4): 241-8. Van Dixhoom J. Ontspanningsinstructie: principes en oefeningen. Maarssen: 2001. Denollet J, Brutsaert DL. Reducing emotional distress improves prognosis in coronary heart disease: 9-year mortality in a clinical trial of rehabilitation. Circulation 2001;104(17): 2018-23. Van Erp J, Donders P. Leven met verandering: verslag van de symposiumreeks Coping en Verwerking bij Chronische Ziekte. The Hague: 2004.

Netherlands Heart Jounal, Volume 13, Number 4, April 2005

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The psychological impact of a cardiovascular disease.

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