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Overcoming anxiety & depression together


Heart2Heart: An integrated approach to cardiac rehabilitation and CBT (2014). 

Elliot M, Salt H, Dent J, Stafford C, Schiza A. British Journal of Cardiac Nursing 9 (10): 338-394



Background: Heart2Heart is a service that integrates cardiac rehabilitation and psychological therapy for patients following myocardial infarction, as well as for those with other cardiac diseases such as heart failure, cardiomyopathy and arrhythmias. Psychosocial support within cardiac rehabilitation programmes has typically been delivered by a specialist psychologist embedded within the cardiac rehabilitation team. Heart2Heart has provided an alternative to this model by developing a more extensive service, which includes primary and secondary care psychological therapists working in a stepped-care way using the improving access to psychological therapies (IAPT) stepped-care approach. Stepped care is the provision of the simplest care possible to achieve the intended aims. The service was one of 15 Department of Health long-term condition pathfinder sites evaluating the feasibility of such a service and was subject to a national evaluation.

Objectives: To provide an acceptable and accessible psychological assessment and treatment service to patients as part of integrated cardiac care. Methods: This project was designed as a feasibility study to develop an innovative service across organisational boundaries. A selection of validated tools was used to measure anxiety, depression and quality of life outcomes. An economic analysis of primary and secondary care service utilisation was also carried out.

Conclusions: The project provided timely and cost-effective cognitive behavioural therapy with high levels of patient satisfaction. Preliminary evidence suggests clinically significant improvements in levels of anxiety, depression and quality of life. Further work is ongoing to explore the economic impact on reducing hospital usage and GP attendance.

Submitted for peer review: 10 April 2014. Accepted for publication: 4 August 2014.

Conflict of interest: This work has been supported by the Department of Health improving access to psychological  Therapies (IAPT) Long-Term Conditions and Medically Unexplained Symptoms Pathfinder project