Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on 'new' conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings.

The study showed that many patients who RTW after angioplasty or heart surgery have poorer work experiences relative to changes in psychological and physical demands and more passive roles.

This study suggests a classification of the causal attributions in patients with cardiac diseases and identifies thematic patterns and unknown attributions. The themes identified can serve as categories for future closed-ended questions.

Obiettivi di questa ricerca sono presentare due diverse modalitŕ di intervento educativo in cardiologia riabilitativa (CR) e valutarne l'efficacia in termini di miglioramento dello stato psicologico dei pazienti. Presso l'Istituto Cardiovascolare di Camogli sono stati reclutati 153 pazienti: 113 hanno partecipato ad un intervento di gruppo chiuso strutturato (gruppo di controllo) costituito da tre incontri con numero fisso di pazienti in cui si trattavano tematiche fondamentali in CR; gli altri 40 pazienti hanno partecipato al gruppo aperto semistrutturato (gruppo sperimentale) nato per meglio venire incontro alle esigenze dei pazienti ricoverati, che ha previsto almeno tre incontri per ciascun paziente. Tutti i pazienti sono stati valutati, all'ingresso e alle dimissioni, con una batteria di questionari indaganti diverse caratteristiche psicologiche. I risultati mostrano come le due modalitŕ portino a esiti positivi sostanzialmente sovrapponibili nel breve termine. Se tali riscontri fossero confermati su gruppi piů ampi, si potrebbero configurare per l'operatore importanti alternative organizzative, senza che l'intervento ne risenta in efficacia.