Clinicians Prove Useful in Helping Cardiac Rehab Patients Reduce Stress

Stress reduction may be an undervalued strategy in helping patients avoid cardiac-related event recurrence.

Current approaches to cardiac rehabilitation typically center on the use of prescription medications, the introduction of daily light-to-moderate physical activity, and adopting a heart-friendly diet. Stress management, while complementary, may also provide powerful benefit when incorporated into a multifaceted cardiac rehabilitation approach.

The findings of a recent study published inCirculationsuggest that a fourth component—stress reduction—is an important strategy for maintaining long-term recovery and reducing the incidence of a second cardiac-related event.

Researchers from Duke Health and UNC Health Care reviewed data from 151 patients with coronary heart disease. Half the cohort received the standard of care, while the remaining half attended a supplementary 90-minute stress management class weekly. These classes consisted of:

· Muscle relaxation exercises

· Group support

· Stress-lowering techniques

· Cognitive behavioral therapy

After a 3-year follow-up, a third of patients (33%) who received standard care alone experienced a second adverse cardiac event, including chest pain, stroke, heart attack, or all-cause death. Meanwhile, just 18% of patients who underwent stress management classes experienced adverse events.

To assess the magnitude of the benefit of cardiac rehabilitation programs, the researchers also evaluated a second patient group that had the same eligibility requirements but chose to forgo cardiac rehabilitation altogether. Of those patients, 47% either experienced a second heart attack of died.

“There is not a single gold standard for measuring stress, which is part of the problem,” Dr. admitted noted study co-author James Blumenthal, PhD, clinical psychologist and professor in psychiatry and behavioral science at Duke University, in a press release. “The stress factor was more nebulous and patients were reluctant to admit they were stressed. Clinicians should get patients to recognize stress is important to their recovery. Simply recognizing how stressful having heart disease can be is an important step.”

Clinicians can play an integral role in a patient’s cardiac rehabilitation, as they understand the importance of both standard and complementary approaches to heart disease management.

Nurse practitioners (NP) in the retail setting can utilize their position in the community and provide much-needed education to cardiac patients regarding the significance of diet, exercise, and stress management for reducing the likelihood of a subsequent cardiac episode.

NPs can also advise patients on the value of behavioral changes that can help to improve cardiac outcomes, including reducing alcohol, the importance of smoking cessation, eliminating the consumption of trans fats, and the value of managing stress.

Although the events that cause stress may be unavoidable, the way a patient responds to these situations is what determines the amount of stress he or she experiences.

Beyond lifestyle changes NPs can encourage patients to take part in stress management courses or refer them to another provider for more in-depth psychological stress therapy.