Helmark Charlotte, Ahm Robert, Andersen Christina M, Skovbakke Søren J, Kok Robin, Wiil Uffe K, Schmidt Thomas, Hjelmborg Jacob, Frostholm Lisbeth, Frydendal Ditte H, Hansen Tina B, Zwisler Ann-Dorthe, Pedersen Susanne S
Department of Cardiology, Zealand University Hospital, Vestermarksvej 21, DK-4000 Roskilde, Denmark.
Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark.
Eur Heart J Digit Health. 2021 Apr 6;2(2):323-335. doi: 10.1093/ehjdh/ztab037. eCollection 2021 Jun.
Anxiety and depression are prevalent in 20% of patients with ischaemic heart disease (IHD); however, treatment of psychological conditions is not commonly integrated in cardiac rehabilitation (CR). Internet-based psychological treatment holds the potential to bridge this gap. To examine the feasibility of an eHealth intervention targeting anxiety and depression in patients with IHD attending CR.
We used a mixed-methods design, including quantitative methods to examine drop-out and change in anxiety and depression scores, and qualitative methods (thematic analysis) to evaluate patients' and nurses' experiences with the intervention. The therapist-guided intervention consisted of 12 modules provided via a web-based platform. The primary outcome was drop-out, with a drop-out rate <25% considered acceptable. Patients were considered as non-drop-out if they completed ≥5 modules. Out of 60 patients screened positive for anxiety and/or depression, 29 patients were included. The drop-out rate was 24% (7/29). Patients had a mean improvement in anxiety and depression scores of 5.5 and 4.6, respectively. On average, patients had 8.0 phone calls with their therapist and 19.7 written messages. The qualitative analysis of patients' experiences identified four themes: treatment platform, intervention, communication with therapist, and personal experience. Patients were positive towards the intervention, although some found the assignments burdensome. From the nurses, we identified three themes: intervention, inclusion procedure, and collaboration with study team. The nurses were positive, however, due to limited time some struggled with the inclusion procedure.
Integrating an eHealth intervention in CR is feasible and the drop-out rate acceptable.
焦虑和抑郁在20%的缺血性心脏病（IHD）患者中普遍存在；然而，心理状况的治疗在心脏康复（CR）中并不常见。基于互联网的心理治疗有潜力弥补这一差距。为了检验针对参加CR的IHD患者焦虑和抑郁的电子健康干预措施的可行性。
我们采用了混合方法设计，包括定量方法来检查焦虑和抑郁评分的退出情况和变化，以及定性方法（主题分析）来评估患者和护士对干预措施的体验。治疗师指导的干预措施由通过基于网络的平台提供的12个模块组成。主要结局是退出，退出率<25%被认为是可接受的。如果患者完成≥5个模块，则被视为未退出。在60名筛查出焦虑和/或抑郁呈阳性的患者中，纳入了29名患者。退出率为24%（7/29）。患者的焦虑和抑郁评分平均分别改善了5.5和4.6。患者平均与治疗师进行了8.0次电话沟通和19.7次书面信息交流。对患者体验的定性分析确定了四个主题：治疗平台、干预措施、与治疗师的沟通以及个人体验。患者对干预措施持积极态度，尽管有些人觉得任务繁重。从护士方面，我们确定了三个主题：干预措施、纳入程序以及与研究团队的合作。护士们持积极态度，然而，由于时间有限，一些人在纳入程序方面遇到困难。
将电子健康干预措施纳入CR是可行的，且退出率可接受。
