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Bedeutung von psychosozialen Faktoren in der Kardiologie – Update 2018

Positionspapier der Deutschen Gesellschaft für Kardiologie

Significance of psychosocial factors in cardiology—Update 2018

Position paper of the German Cardiac Society

  • Positionspapier
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Hintergrund

Psychosoziale Faktoren bei Herz-Kreislauferkrankungen sind zunehmend in das Bewusstsein von Patienten, Leistungserbringern und Kostenträgern gerückt. Aufgrund der rasch anwachsenden Evidenz hat die Deutsche Gesellschaft für Kardiologie ein Update des gleichnamigen Positionspapiers aus dem Jahr 2013 in Auftrag gegeben.

Methoden

Der Stand des Wissens zu den wichtigsten Herz-Kreislauferkrankungen wird synoptisch dargestellt und es werden Empfehlungen für die Berücksichtigung psychosozialer Aspekte in der klinischen Praxis abgeleitet.

Ergebnisse

Psychosoziale Faktoren wie niedriger sozialer Status, akuter oder chronischer Stress, Depression, Angst und Mangel an sozialer Unterstützung sind mit einem erhöhten Erkrankungsrisiko und mit einem ungünstigeren Krankheitsverlauf verknüpft. Psychosoziale Belastungen und psychische Begleiterkrankungen sollten routinemäßig erfasst werden, sodass sich ggf. gezielt weitere Diagnostik und Therapie anschließen können. Allen Patienten soll ein Behandlungsangebot gemacht werden, das alters- und geschlechtsspezifische Aspekte sowie die individuellen Präferenzen der Patienten berücksichtigt. Multimodale Behandlungsansätze sollen Wissensvermittlung, Sport- und Bewegungstherapie, Motivationsförderung sowie Entspannungsverfahren bzw. Stressmanagement umfassen. Bei psychischer Komorbidität sollen psychosomatische Grundversorgung sowie psychotherapeutische Interventionen und/oder Medikation angeboten werden. Bei guter Wirksamkeit auf psychische Symptome ist ein Effekt hinsichtlich der kardialen Prognose noch unklar.

Schlussfolgerungen

Bei der KHK, Herzinsuffizienz, arteriellen Hypertonie und bei Herzrhythmusstörungen besteht eine robuste Evidenz hinsichtlich der Bedeutung psychosozialer Faktoren, die eine Berücksichtigung in der kardiologischen Versorgung sinnvoll macht. Der Grad der Umsetzung in der klinischen Praxis ist jedoch defizitär und der Effekt psychotherapeutischer bzw. pharmakologischer Interventionen auf die Prognose ungewiss. Entsprechend werden sowohl weitere Behandlungsstudien als auch intensivierte Fort- und Weiterbildungsangebote gefordert.

Abstract

Background

Psychosocial factors in cardiovascular diseases are increasingly acknowledged by patients, healthcare providers and payer organizations. Due to the rapidly increasing body of evidence the German Society for Cardiology commissioned an update of its 2013 position paper on this topic.

Methods

This position paper provides a synopsis of the state of knowledge regarding psychosocial factors in the most relevant cardiovascular diseases and gives recommendations with respect to their consideration in clinical practice.

Results

Psychosocial factors such as low socioeconomic status, acute and chronic stress, depression, anxiety and lack of social support are associated with an increased risk of diseases and an unfavorable prognosis. Psychosocial problems and mental comorbidities should be assessed routinely to initiate targeted diagnostics and treatment. For all patients, treatment should consider age and sex-specific differences as well as individual patient preferences. Multimodal treatment concepts should comprise education, physical exercise, motivational counselling and relaxation training or stress management. In cases of mental comorbidities, basic psychosomatic treatment and psychotherapeutic interventions by primary care providers or cardiologists, regular psychotherapy and/or medication should be offered. While these interventions have positive effects on psychological symptoms, robust evidence for possible effects on cardiac outcomes is still lacking.

Conclusion

For coronary heart disease, chronic heart failure, arterial hypertension, and some arrhythmias there is robust evidence supporting the relevance of psychosocial factors, pointing to a need for considering them in cardiological care; however, there are still shortcomings in implementing psychosocial treatment and prognostic effects of psychotherapy and psychotropic drugs remain uncertain. There is a need for enhanced provider education and more treatment trials.

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Authors and Affiliations

  1. Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universität zu Köln, Kerpenerstr. 62, 50937, Köln, Deutschland

    C. Albus FESC

  2. Klinik für Psychosomatische Medizin und Psychotherapie, Klinikum Nürnberg, Nürnberg, Deutschland

    C. Waller

  3. Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland

    K. Fritzsche

  4. Klinik für Kardiologie, Herzzentrum, Universität Leipzig, Leipzig, Deutschland

    H. Gunold

  5. Klinik für Kardiologie, Angiologie und Intensivmedizin, Theresienkrankenhaus, Mannheim, Deutschland

    M. Haass

  6. Abteilung Psychokardiologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland

    B. Hamann

  7. Klinik für Innere Medizin III (Kardiologie/Angiologie/Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg, Deutschland

    I. Kindermann

  8. Abteilung Psychosomatik und Verhaltenstherapie, Reha-Zentrum Seehof, Teltow, Deutschland

    V. Köllner

  9. Praxis für Kardiologie, Preventive Care Center, Hamburg, Deutschland

    B. Leithäuser

  10. Med. Klinik I – Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland

    N. Marx

  11. Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland

    N. Marx

  12. Klinik für Kardiologie, Klinik Würzburg Mitte – Standort Juliusspital, Würzburg, Deutschland

    M. Meesmann

  13. Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Mainz, Mainz, Deutschland

    M. Michal

  14. Department für Psychosomatik, Klinik Barmelweid, Barmelweid, Schweiz

    J. Ronel

  15. Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    M. Scherer

  16. Kardiopulmonale Schwerpunktpraxis, Nürnberg, Deutschland

    V. Schrader

  17. Curschmann Klinik, Timmendorfer Strand, Deutschland

    B. Schwaab

  18. Abteilung für Psychosomatische Medizin und Psychotherapie, Klinik Hennigsdorf, Hennigsdorf, Deutschland

    C. S. Weber

  19. Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Göttingen, Göttingen, Deutschland

    C. Herrmann-Lingen

  20. Universitätsklinik der Paracelus Medizinischen Privatuniversität, Salzburg, Österreich

    C. Waller

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  1. C. Albus FESC
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  2. C. Waller
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  16. B. Schwaab
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  18. C. Herrmann-Lingen
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Corresponding author

Correspondence to C. Albus FESC.

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Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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N. Marx hat an diesem Beitrag für die Kommission für Klinische Kardiovaskuläre Medizin der DGK mitgewirkt.

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Albus, C., Waller, C., Fritzsche, K. et al. Bedeutung von psychosozialen Faktoren in der Kardiologie – Update 2018. Kardiologe 12, 312–331 (2018). https://doi.org/10.1007/s12181-018-0271-4

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