In-hospital management of psychological responses to acute cardiac events

Abstract

Many patients experience significant psychological distress after admission to hospital following acute coronary syndrome or to undergo percutaneous coronary angioplasty, coronary artery bypass surgery, or other cardiac surgery. Anxiety and depression are common emotional responses to these acute cardiac events and may be preexisting conditions. Symptoms of cognitive impairment, post-traumatic stress disorder, delirium, and major denial may also be present in hospitalized cardiac patients. Although gaps in knowledge exist concerning the impact and course of these disorders, there is now sufficient evidence showing their detrimental effects upon patients' recovery. The importance of early detection and management of depression, in particular, is essential to help prevent unwarranted psychological disability. Screening of patients is recommended in hospital and at appropriate intervals during follow-up. Brief screening tools are available which can be routinely administered. In addition, doctors and other health professionals should be aware of the clinical features of common psychological reactions of hospitalized patients to ensure prompt recognition and assessment. The important role of doctors in the clinical management of patients with anxiety and depression symptoms is stressed. However, referrals for the management of acutely distressed patients should be made to health professionals who have specific training in the treatment of psychological problems. Past studies have reported benefits from some depression treatments, especially those based on cognitive behavioral therapy. However, further rigorous research is required to develop, implement, and evaluate interventions for the early alleviation of symptoms of depression and other psychological conditions. Coordinated care of patients by a multidisciplinary team is essential. Encouragement of patients to attend a group cardiac rehabilitation program is highly recommended.