Psychological Interventions in Cardiovascular Disease
Psychological Interventions in Cardiovascular Disease
The identification and classification of psychological intervention studies is a major challenge due to the wide variety of interventions evaluated, which are sometimes not described in sufficient detail. In complex and multidimensional programmes, replication of the studies will be required but can be difficult, as it is hard to isolate the active components due to the possible synergistic effects of the interventions. Many studies reported psychological outcomes, but had not performed psychological interventions to influence these outcomes. In addition, studies that claimed to use psychological interventions may not necessarily have included psychological components. For instance, telephone-based consultations enquiring about clinical progress and offering clinical advice could be better classified as telemonitoring, as it fulfills the purpose of a clinic visit while removing the burden of travelling either on the part of the care deliverer or recipient. Although one may argue that the phone call offers reassurance, this would not have been likely to be above and beyond the reassurance received had the telephone consultation been replaced by a clinic consultation. Cost-effectiveness should also be considered, with one study concluding that the cost per Quality Adjusted Life Year gained in the ProActive HEART program, was above acceptable limits compared with usual care. In addition, many previous studies have included highly varied patient groups. More stringent patient selection directed specifically at those with obvious and persistent psychological-risk factors or symptoms should also be considered, as this variation may have explained the positive results of some studies.
Challenges and Considerations
The identification and classification of psychological intervention studies is a major challenge due to the wide variety of interventions evaluated, which are sometimes not described in sufficient detail. In complex and multidimensional programmes, replication of the studies will be required but can be difficult, as it is hard to isolate the active components due to the possible synergistic effects of the interventions. Many studies reported psychological outcomes, but had not performed psychological interventions to influence these outcomes. In addition, studies that claimed to use psychological interventions may not necessarily have included psychological components. For instance, telephone-based consultations enquiring about clinical progress and offering clinical advice could be better classified as telemonitoring, as it fulfills the purpose of a clinic visit while removing the burden of travelling either on the part of the care deliverer or recipient. Although one may argue that the phone call offers reassurance, this would not have been likely to be above and beyond the reassurance received had the telephone consultation been replaced by a clinic consultation. Cost-effectiveness should also be considered, with one study concluding that the cost per Quality Adjusted Life Year gained in the ProActive HEART program, was above acceptable limits compared with usual care. In addition, many previous studies have included highly varied patient groups. More stringent patient selection directed specifically at those with obvious and persistent psychological-risk factors or symptoms should also be considered, as this variation may have explained the positive results of some studies.
