When someone suffers a heart attack or undergoes a major heart repair procedure, emotional side effects often arise for the patient.
Heart patients, both men and woman, sometimes struggle with depression or anxiety after an “event” or surgery, says Amie Allanson, network director of clinical therapies.
“We see a lot of people with mood swings, depression, guilt and other side effects, that snowball into a mental health issue,” she says.
“Their life has changed: they may now be limited in their physical, lifestyle and professional activities. They may suffer from guilt due to their condition, reduced income or a lost job.”
She estimates that behavioral health professionals in her department treat around 50 percent of people who have experienced heart issues, but not just the individual him or herself.
“We often treat the families of patients, too, because they’re affected as well.”
Cardiologist Francis Burt, MD, says some of his patients confide during follow-up office visits their struggles with depression or fears they might suffer another heart attack.
“First there’s shock of the heart attack, then relief of having survived,” says St. Luke’s medical director for cardiac rehabilitation. “Then comes the reality and fear that it might happen again sink in after a few weeks.” He notes that recurrent heart attacks are rare, though not unseen.
Cardiac nurses and advanced practice clinicians, like nurse practitioners, educate patients before discharge on their new medications, heart health and lifestyle improvements like blood pressure control, smoking cessation or starting or increasing exercise.
“We all support our patients to help them adjust,” Dr. Burt says. “Men, in particular, seem to have an emotional backlash from a heart attack then women, because they often think they’re invincible until the event.”
Most patients are referred by their cardiologist to cardiac rehabilitation within a month after a heart attack or several months following heart bypass surgery. This 12-week program of telemetry monitored exercise, lifestyle and diet instruction and emotional support has been shown through scientific studies to reduce death rates after heart attacks, notes Dr. Burt.
“Cardiac rehab is a standard of care for our patients at St. Luke’s,” he adds.
Bill Merkert, St. Luke’s manager of cardiac rehabilitation, says many new patients come to the program pumped with optimism, with “a new lease on life” following a treated heart problem. But some are scared initially after facing “a life-altering event and a sense of their own mortality.”
“It can be blessing for some, a time to alter their lifestyle and improve their quality of life,” says the 33-year veteran of the specialty. Each cardiac rehab patient completes a questionnaire that screens for depression and anxiety during their initial at cardiac rehab and then every 30 days, Merkert says.
Emotional stress after a heart attack is common, and exercise can help control it, which is a major benefit of the program, Merkert adds. Formal teaching and support are also provided to each patient by staff and the impact is noteworthy.
“We see them improve their health, commit to changing habits that might have brought on the heart disease, and we encourage them to feel confident enough to exercise independently at home.”
Patients who are experiencing “advanced anxiety or depression” are referred for Behavioral Health consultations, Merkert notes. “We are sure to address those extreme cases.”
In addition to the in-person therapy sessions conducted by Behavioral Health social workers, psychologists and therapists, virtual individual and family counseling is available for patients through SilverCloud, the digital mental health telemedicine platform offered by St. Luke’s, says Allanson.
“We also provide mindfulness meditation training, substance abuse screening and treatment, medication prescribing, and advice on other self-care activities, including journaling.”
She estimates it may take four to six months to guide a patient to understand what they’re feeling, reframe their thinking about it and adjust to their new life, which can also be a healthier, more optimistic one.