Cardiac Rehabilitation Patients' Accounts of Their Emotional Distress and Psychological Needs: A Qualitative Study.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE

Original Publication: Oxford : Wiley-Blackwell

Emotions*; Anxiety/*psychology ; Cardiac Rehabilitation/*psychology ; Depression/*psychology ; Heart Diseases/*rehabilitation ; Stress, Psychological/*psychology; Adaptation, Psychological ; Affect ; Anxiety/diagnosis ; Depression/diagnosis ; England ; Health Knowledge, Attitudes, Practice ; Heart Diseases/diagnosis ; Heart Diseases/psychology ; Humans ; Interviews as Topic ; Mental Health ; Qualitative Research ; Randomized Controlled Trials as Topic ; Stress, Psychological/diagnosis ; Treatment Outcome

Background Psychological distress is prevalent among patients with cardiovascular disease and is linked to increased risk of future cardiac events. Cardiac rehabilitation (CR) is widely recommended for treating psychological distress but has been of limited benefit. This study aims to understand how distressed cardiac patients describe their emotional needs and the response of CR. Methods and Results A qualitative descriptive study was conducted with 46 patients who screened positively for anxiety and/or depression. Semi-structured interviews were held, and data were analyzed using a constant comparative approach. Patients described low mood and diverse concerns, including threat of another cardiac event, restrictions on their lives, and problems unrelated to their health. Patients described worrying constantly about these concerns, worrying about their worry, and feeling that worry was uncontrollable and harmful. Patients wanted to "get back to normal" but lacked any sense of how to achieve this and were reluctant to discuss their worries with CR staff. They hoped to recover over time, meanwhile seeking reassurance that they were responding "normally." Patients were mostly dismissive of psychological techniques used in CR. Conclusions These findings expose a conundrum. Distressed CR patients have diverse worries but do not generally want to discuss them, so they invest hopes for feeling better in time passing and reassurance. An intervention acceptable to CR patients would allow them to address diverse worries but without having to share the content of worries, would have "face validity," and would address patients' worry about worry. Metacognitive therapy is an intervention that might be suitable. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02420431.

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RP-PG-1211-20011 United Kingdom DH_ Department of Health; RP‐PG‐1211 20011 United Kingdom DH_ Department of Health

Keywords: cardiovascular disease; mental health; quality and outcomes

ClinicalTrials.gov NCT02420431

Date Created: 20190822 Date Completed: 20200831 Latest Revision: 20240717

20240717

PMC6585358

10.1161/JAHA.118.011117

31433708