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. 2021 Jul 16;22(1):455.
doi: 10.1186/s13063-021-05405-3.

Intensive group-based cognitive therapy in patients with cardiac disease and psychological distress-a randomized controlled trial protocol

Annette Holdgaard  1 , Christine Eckhardt-Hansen  2 , Thomas Lund  2 , Christina Funch Lassen  2 , Kirstine Lærum Sibiliz  3 , Dan Eik Høfsten  3 , Eva Prescott  4 , Hanne Kruuse Rasmusen  4
Affiliations

Intensive group-based cognitive therapy in patients with cardiac disease and psychological distress-a randomized controlled trial protocol

Annette Holdgaard et al. Trials. .

Abstract

Background: Many patients with coronary artery disease (CAD) and valvular heart disease (VHD) suffer from psychological distress. Such stress is associated with increased morbidity, reduced quality of life and delayed return to work. European guidelines emphasize recognition and intervention, but evidence-based treatment options are limited and perceived as costly. The present study will test the effect of brief, group-based cognitive therapy as an adjunct to usual cardiac rehabilitation in a randomized design.

Methods: A total of 148 patients with CAD and/or VHD after surgical intervention and concomitant psychological distress (defined as HADS anxiety (A) or depression (D) score ≥8) will be randomized to either usual out-patient cardiac rehabilitation (CR) comprising an 8-week multidisciplinary programme or usual care supplemented by five group-based cognitive therapy sessions performed by trained CR nurses. A structured, standardized treatment manual will be used. Patients will be randomized 1:1 at three different sites. Additionally, a non-randomized sub-group of 40 matched patients without signs of psychological distress will be followed to investigate spontaneous variation in HADS. The primary outcome is Hospital Anxiety and Depression Score (HADS). Secondary outcomes are adherence to cardiac rehabilitation (CR), health-related quality of life measured by HeartQoL, time to return to work, adherence to lifestyle interventions and cardiovascular readmissions. Patients are followed up for 12 months.

Discussion: To our knowledge, this is the first randomized controlled trial (RCT) on patients with cardiac disease with an intensive group-based programme of cognitive therapy performed by CR nurses, which makes it affordable and widely implementable. The outcome will elucidate the feasibility and effect of cognitive therapy as an adjunct to CR in patients with post-surgery CAD and/or VHD and psychological distress and could possibly benefit patients with other heart conditions as well. The clinical trial complies with the Declaration of Helsinki. The trial has been approved by The Regional Research Ethics Committee (file number H-16042832) and The Danish Data Protection Agency. The results will be disseminated as original research in peer-reviewed manuscripts.

Trial registration: www.clinicaltrials.gov NCT04254315 . Retrospectively registered on 30 January 2020.

Keywords: Anxiety; Cardiac rehabilitation; Cognitive therapy; Coronary heart disease; Depression; HADS; Psychological distress.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The trial diagram. Flow of patients. Participants in the intervention group follow CR and five sessions of CBT therapy and the control group follow standard CR
Fig. 2
Fig. 2
The matrix shows the significance of discovering one’s values to overcome difficulties
Fig. 3
Fig. 3
Circle of anxiety demonstrates a correlation between thoughts, feelings and behaviour. The anxiety circle is inspired by Esben Hougaard
Fig. 4
Fig. 4
Behavioural analysis demonstrates the consequences of behaviour and what leads to the behaviour
See this image and copyright information in PMC

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