ONLINE COGNITIVE BEHAVIORAL THERAPY TARGETING CARDIAC ANXIETY FOLLOWING MYOCARDIAL INFARCTION

Background:Myocardial infarction is one of the leading causes of health loss globally, representing a large proportion of general disability. Anxiety and depression occur in 20-30 percent of patients following MI and have been identified as risk factors for recurrent adverse cardiac events and are associate d with low levels of exercise, fatigue, poor quality of life (QoL) a well as a barrier to comply with cardiac re habilitation.

Thus, psychological factors, such as fear f cardiac symptoms and avoidance behavior (i.e., cardiac anxiety) may affect the clinical course following MI and play an important role in poor adherence to cardiac rehabilitation and the development of disability and low QoL.

Objectives:The purpose of our research program is to develop and evaluate a disease specific internet-based cognitive behavioral therapy (CBT) protocol to reduce cardiac anxiety, depression, and increase physical activity and quality of life (QoL) in patients following myocardial infarction. In addition we will conduct a full health economic evaluation of internet-CBT for post MI patients.

Work plan:This project is an interdisciplinary collaboration between CBT researchers and researchers and specialists in cardiology at Karolinska University hospital/Karolinska Institutet. Our research group has developed a CBT protocol for cardiac anxiety in patients with atria fibrillation that showed large improvements in QoL, mental and physical well-being In the present research program, we have recently adapted and evaluate this CBT protocol for MI patients.

In a first pilot study we met MI patients face-to-face and developed the treatment protocol. This protocol will be transferred into an internet-delivered treatment. The project comprises a internet-CBT pilot trial and two randomized controlled studies that will evaluate the efficacy of internet-CBT targeting cardiac anxiety for post MI patients compared to usual care and attention-control.

Significance:If this novel interdisciplinary approach demonstrates increased QoL and physical, it is expected to have significant impact on secondary prevention following MI. Internet-CBT can be made accessible within the near future and implemented in clinical practice to the benefit of the large target population.