Using the mind to help with healing

After a spell of bronchitis led to pneumonia and then heart failure, Sara Bement found her physical ailments had psychological consequences.

“I got angry and very short-tempered at times,” said Bement, 71, of Winsted, Conn., who has had a defibrillator and pacemaker installed since her heart failure 23 years ago. When her husband passed away 10 years ago, and then she had to retire from her job at an elementary school, Bement lost key support and her familiar routine.

“You figure, why me?” said Bement. “There are times I just don’t want to do anything.”

A cardiac support group at the University of Connecticut Health Center has helped remind Bement that she’s not alone — support is critical not just for a patient’s emotional well-being, but for the heart’s prognosis. Not only does cardiac illness increase a person’s risk of mental distress, many studies have shown, but mental ailments can exacerbate, and even cause, poor heart health.

“It’s a vicious circle,” said Dr. Angelos Halaris, medical director of adult psychiatry at Loyola University Medical Center in Maywood, Ill.

Halaris is pushing to develop a subdiscipline at Loyola he would like to call psychocardiology, which would bridge cardiology, psychiatry, psychology and nursing to address risk factors early on.

“I’m not trying to make cardiologists out of psychologists, but to have some degree of cross-training,” he said. “What I’m proposing first and foremost (is) to accept and espouse that we need to take a more integrative, holistic approach to assessing and managing and treating our patients.”

His efforts aim to formalize and expand on an existing specialty widely known as cardiac psychology, or behavioral cardiology. Cardiac psychologists generally identify cardiac patients who may be depressed or socially isolated to help them manage stress and adhere to medicine or lifestyle prescriptions.

“Social isolation is as strong a risk factor as smoking,” said Robert Allan, clinical assistant professor of psychology in medicine at Weill Cornell Medical College and co-author of “Heart and Mind: The Practice of Cardiac Psychology,” originally printed in 1996.

Addressing the psychosocial aspect of cardiac disease has become particularly important as hospitals strive to reduce readmissions. As part of the Affordable Care Act, in 2012 Medicare implemented penalty fees for hospitals that have 30-day readmission rates above the national average for heart attack, heart failure and pneumonia.

At the University of Connecticut Health Center, one of the key strategies to reduce readmissions was to designate social worker Sue Eisenberg to the cardiac unit so that she can identify high-risk patients and communicate their emotional, financial and practical needs to the cardiac team. It had great effect. Within a year of implementing the new measures, 30-day readmission rates for heart-failure patients fell from 26.1 to 19.1 percent, said Wendy Martinson, the hospital’s quality-assurance specialist.

Eisenberg, who runs the cardiac support group at UConn, said the most common plight she sees is isolation, as even people with family and friends often feel that no one understands the dread that grips them. In addition to providing an understanding audience, the support group provides heart-healthy recipes and invites family members to join so that they can learn how to help.

The link between mental and heart health is bi-directional. Otherwise healthy people with depression or other mental illnesses are more likely to develop cardiac illness later in life, studies have shown. And cardiac patients are more likely to develop stress-related disorders.

The American Heart Association in 2008 issued a scientific statement recommending all heart patients be screened for depression, citing studies that show depression is three times more common in heart attack patients than in the general population. Depressed cardiac patients have at least twice the risk of a second adverse cardiac event in the one to two years after having a heart attack than patients without depression, according to the American Heart Association.

Similarly, heart disease patients who suffer anxiety have twice the risk of dying in three years compared to those without anxiety, according to research published last year in the Journal of the American Heart Association. And 1 in 8 heart attack patients develop post-traumatic stress disorder, which doubles their risk of dying of a second event over the next one to three years, a 2012 study out of Columbia University Medical Center found.

The increased risk is partly related to lifestyle. People under severe emotional strain are more likely to engage in unhealthy activities like smoking, overeating and physical inactivity, which are risk factors for coronary disease. And they are less likely to take medication or visit the doctor.

But physiological processes also raise the risk that a person with depression or other stress-related disorders in young adulthood will develop cardiovascular disease, Loyola’s Halaris said. Not only can mental stress increase blood pressure, but the immune system’s response to the stress sets off alarms throughout the body that increase inflammation, which over the years hurts the heart.

“The cardiovascular system is particularly vulnerable to chronic inflammation, resulting in blood vessel changes centrally and peripherally that eventually lead to the condition we know as arteriosclerosis, which can ... result in heart attacks or stroke,” said Halaris, who studies the link between depression and heart health. “We are seeing early signs of pending vascular changes in young people with depression.”

Meantime, positive psychological well-being appears to cut the risk of heart attacks, stroke and other cardiovascular events. A recent study from the Harvard School of Public Health found that optimism, life satisfaction and happiness are associated with reduced risk of cardiovascular disease regardless of the person’s weight, smoking status and other risk factors.

aelejalderuiz@tribune.com

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