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Findings show it is effective and feasible to combine cardiac nurse-led cognitive-behavioral therapy with cardiac rehab.

Cognitive-behavioral therapy (CBT) provided by cardiac nurses in conjunction with cardiac rehabilitation (CR) cuts anxiety and depression symptoms in heart patients, according to a study published online Jan. 18 in the European Heart Journal.

Annette Holdgaard, from Bispebjerg and Frederiksberg Hospital in Denmark, and colleagues assessed whether usual outpatient CR plus CBT visits from cardiac nurses with CBT training (supervised by a psychologist) reduces anxiety and depression. The analysis included 147 cardiac patients (67 percent men; mean age, 54 years) with identified psychological distress (anxiety and/or depression) who were randomly assigned to five sessions of group CBT plus usual CR (intervention; 74 participants) or CR alone (control; 73 participants). An additional 41 consecutive patients without psychological distress receiving usual CR (background group) were also included to explore the effect of time on the outcome.

The researchers found that the total Hospital Anxiety and Depression Scale (HADS) score after three months improved more in the intervention group than in the control group (mean total improvement, 8.0 versus 4.1). Between-group differences remained significant after six months. The intervention group also had greater adherence to CR, more improvement in heart-related quality of life at six months, and a significant reduction in cardiac readmissions at 12 months versus the control group. There were no significant changes seen in the HADS score over time for the background group.

“The findings indicate that all patients attending cardiac rehabilitation should be screened for psychological distress and offered CBT if needed,” Holdgaard said in a statement. “Those in the therapy group said it was a relief being with others dealing with the same problems.”

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