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Individuals with cardiovascular disease, including patients recovering from a heart attack or absorbing a new diagnosis of heart failure, often experience a range of emotional adjustment difficulties.
At The University of Toledo Medical Center, mental and behavioral health concerns are addressed head-on as part of the hospital’s interdisciplinary cardiovascular rehabilitation program.
“Many studies show things such as low mood, anxiety and stress can slow recovery from a medical condition and/or increase risk for future cardiovascular events,” said Dr. Jason C. Levine, a clinical psychologist at UTMC. “It also works in the other direction, in that receiving a new diagnosis or undergoing a medical procedure can cause adjustment difficulties such as stress, anxiety and low mood. We’re really trying to support the patient from all angles to promote better outcomes and quality of life.”
In addition to cardiologists, exercise physiologists, dieticians and specially trained cardiac rehabilitation nurses, patients enrolled in cardiovascular rehabilitation at UTMC work directly with behavioral health providers to help them address immediate behavioral and mental health issues and build a plan for how to deal with them in the short and long term.
Levine, who oversees cardiac behavioral medicine at UTMC, said the service sets UTMC’s cardiovascular rehabilitation program apart from others.
While most programs provide only an educational class on stress management, behavioral health is a fundamental part of UTMC’s overall program.
“Very few cardiac rehab programs have an integrated behavioral medicine service,” he said. “We’re fortunate that we do, and I really do think that our program is a model in that regard.”
Patients are screened for depression, anxiety, stress and suicidal thoughts at the beginning of the cardiac rehab program. If concerns are identified in any of those areas, they are immediately referred to the program’s behavioral health team. All participants are offered cardiac behavioral medicine services.
Levine said the level of involvement depends on the specific needs of the patient — behavioral health providers may see an individual once or twice or at every visit for the duration of the 12-week program.
Heart disease and depression are highly interconnected.
Not only is depression a risk factor for developing heart problems, but new diagnoses or cardiac events can exacerbate existing mental health problems and lead to new ones.
Overall, the rate of depression is significantly higher in cardiac patients than the population at large. A 2014 study published in the journal Annals of Behavioral Medicine, for example, found between 20% and 30% of cardiac patients experience depression.
“Depression not only leads to poorer health outcomes, but it also is a barrier to following through and completing cardiac rehab, and it predicts poor adherence to medications,” said Levine, who also is an associate professor of psychiatry in the UToledo College of Medicine and Life Sciences. “There’s a strong argument to be made about the importance of addressing and targeting behavioral health issues in this population.”
Beyond addressing depression, anxiety and stress, the behavioral medicine team at UTMC also works with other healthcare providers to promote healthy lifestyle changes, such as smoking cessation, weight loss and more effectively managing other chronic conditions like diabetes.
“Our primary goal really is to help patients get the best out of their cardiac rehab program,” Levine said. “We want to broadly address any psychological issues that patients may be experiencing and provide them tools to adopt healthier lifestyles. All of these things help patients have a more successful rehabilitation and live a higher quality