Pedersen Susanne S, von Känel Roland, Tully Phillip J, Denollet Johan
1 Department of Psychology, University of Southern Denmark, Denmark.
2 Department of Cardiology, Odense University Hospital, Denmark.
Eur J Prev Cardiol. 2017 Jun;24(3_suppl):108-115. doi: 10.1177/2047487317703827.
Adaptation to living with cardiovascular disease may differ from patient to patient and is influenced not only by disease severity and limitations incurred by the disease but also by socioeconomic factors (e.g. health literacy), the patients' psychological make-up and susceptibility to distress. Co-morbid depression and/or anxiety is prevalent in 20% of patients with cardiovascular disease, which may be either transient or chronic. Distress, such as depression, reduces adherence, serves as a barrier to behaviour change and the adoption of a healthy lifestyle, and increases the risk that patients drop out of cardiac rehabilitation, impacting on patients' quality of life, risk of hospitalisation and mortality. Hence it is paramount to identify this subset of high-risk patients in clinical practice. This review provides a general overview of the prevalence of selected psychosocial risk factors, their impact on patient-reported and clinical outcomes, and biological and behavioural mechanisms that may explain the association between psychosocial factors and health outcomes. The review also provides recommendations on which self-report screening measures to use to identify patients at high risk due to their psychosocial profile, and the effectiveness of available trials that target these risk factors. Despite challenges and barriers associated with screening of patients combined with appropriate treatment, it is paramount that we treat not only the heart but also the mind in order to improve the quality of care and patient and clinical outcomes.
对心血管疾病患者生活的适应情况因人而异，不仅受疾病严重程度和疾病所致限制的影响，还受社会经济因素（如健康素养）、患者心理构成以及易产生痛苦的程度影响。共病抑郁和/或焦虑在20%的心血管疾病患者中普遍存在，可能是短暂的，也可能是慢性的。诸如抑郁等痛苦情绪会降低依从性，成为行为改变和采取健康生活方式的障碍，并增加患者退出心脏康复治疗的风险，进而影响患者的生活质量、住院风险和死亡率。因此，在临床实践中识别这一高危患者亚组至关重要。本综述概述了所选心理社会风险因素的患病率、它们对患者报告结局和临床结局的影响，以及可能解释心理社会因素与健康结局之间关联的生物学和行为机制。该综述还就使用哪些自我报告筛查措施来识别因心理社会特征而处于高危的患者，以及针对这些风险因素的现有试验的有效性提供了建议。尽管在对患者进行筛查并给予适当治疗方面存在挑战和障碍，但为了提高护理质量以及患者和临床结局，我们不仅要治疗心脏，还要关注心理，这一点至关重要。
