Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

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Marinella Sommaruga *
Elisabetta Angelino
Paola Della Porta
Mara Abatello
Giacomo Baiardo
Gianluigi Balestroni
Ornella Bettinardi
Edward Callus
Chiara Ciracì
Ombretta Omodeo
Claudia Rizza
Paolo Michielin
Marco Ambrosetti
Raffaele Griffo
Roberto F.E. Pedretti
Antonia Pierobon
(*) Corresponding Author:
Marinella Sommaruga |


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.

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Article Details

Author Biographies

Marinella Sommaruga, Istituti Clinici Scientifici Maugeri IRCCS Milan, Psychology Unit

Psychology Unit

Elisabetta Angelino, Istituti Clinici Scientifici Maugeri IRCCS Turin, Psychology Unit


Psychology Unit


Paola Della Porta, FERB Onlus Rehabilitation Center of Cernusco sul Naviglio

Psychologist at FERB Onlus Rehabilitation Center

Gianluigi Balestroni, Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS Veruno

Psychology Unit

Edward Callus, Polyclinic San Donato IRCCS, Clinical Psychology Service

Clinical Psychology Service

Ombretta Omodeo, Istituti Clinici Scientifici Maugeri IRCCS Pavia, Psychology Unit

Psychology Unit

Paolo Michielin, University of Padua, Department of Psychology

Dipartimento di Psicologia

Marco Ambrosetti, Le Terrazze Clinic, Cardiovascular Rehabilitation Unit

Cardiovascular Rehabilitation Unit

Roberto F.E. Pedretti, Istituti Clinici Scientifici Maugeri IRCCS Pavia, Department of Cardiology

Dipartimento di Cardiologia

Antonia Pierobon, Istituti Clinici Scientifici Maugeri IRCCS Montescano, Psychology Unit

Psychology Unit