Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany.
Clin Res Cardiol. 2019 Nov;108(11):1175-1196. doi: 10.1007/s00392-019-01488-w. Epub 2019 May 10.
Psychosocial factors in cardiovascular diseases are increasingly acknowledged by patients, health care providers and payer organizations. Due to the rapidly increasing body of evidence, the German Cardiac Society has commissioned an update of its 2013 position paper on this topic. The German version was published in 2018 and the current manuscript is an extended translation of the original version.
This position paper provides a synopsis of the state of knowledge regarding psychosocial factors in the most relevant cardiovascular diseases and gives recommendations with respect to their consideration in clinical practice.
Psychosocial factors such as low socioeconomic status, acute and chronic stress, depression, anxiety and low social support are associated with an unfavorable prognosis. Psychosocial problems and mental comorbidities should be assessed routinely to initiate targeted diagnostics and treatment. For all patients, treatment should consider age and gender differences as well as individual patient preferences. Multimodal treatment concepts should comprise education, physical exercise, motivational counseling and relaxation training or stress management. In cases of mental comorbidities, brief psychosocial interventions by primary care providers or cardiologists, regular psychotherapy and/or medications should be offered. While these interventions have positive effects on psychological symptoms, robust evidence for possible effects on cardiac outcomes is still lacking.
For coronary heart disease, chronic heart failure, arterial hypertension, and some arrhythmias, there is robust evidence supporting the relevance of psychosocial factors, pointing to a need for considering them in cardiological care. However, there are still shortcomings in implementing psychosocial treatment, and prognostic effects of psychotherapy and psychotropic drugs remain uncertain. There is a need for enhanced provider education and more treatment trials.
心血管疾病中的心理社会因素越来越受到患者、医疗保健提供者和支付方组织的认可。由于证据迅速增加，德国心脏病学会委托对其 2013 年关于该主题的立场文件进行更新。德语版于 2018 年发表，目前的手稿是原始版本的扩展翻译。
本立场文件概述了与心血管疾病中最相关的心理社会因素的知识状况，并就其在临床实践中的考虑提出了建议。
社会经济地位低、急性和慢性压力、抑郁、焦虑和低社会支持等心理社会因素与预后不良相关。应常规评估心理社会问题和精神合并症，以启动针对性诊断和治疗。所有患者的治疗都应考虑年龄和性别差异以及个体患者的偏好。多模式治疗概念应包括教育、体育锻炼、动机咨询以及放松训练或压力管理。对于精神合并症，应提供初级保健提供者或心脏病专家的简短心理干预、定期心理治疗和/或药物治疗。虽然这些干预措施对心理症状有积极影响，但关于它们对心脏结局可能产生的影响仍缺乏有力证据。
对于冠心病、慢性心力衰竭、动脉高血压和一些心律失常，有强有力的证据支持心理社会因素的相关性，表明需要在心脏科护理中考虑这些因素。然而，在实施心理社会治疗方面仍存在不足，心理治疗和精神药物的预后效果仍不确定。需要加强提供者教育和更多的治疗试验。
