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New treatment significantly improves mental health in heart disease patients

Mental health treatment Metacognitive Therapy (MCT) significantly improves symptoms of anxiety and depression for heart disease patients, an NIHR-funded study has found.

The findings, published in the American Heart Association journal Circulation, are a huge step towards better informed and well-rounded care for heart disease patients, with the potential to improve not only mental health, but also the physical health of those recovering from heart disease.

The PATHWAY study, led by led by Greater Manchester Mental Health NHS Foundation Trust and the University of Manchester, evaluated the effectiveness of delivering MCT, alongside normal Cardiac Rehabilitation (CR) services, in treating symptoms of anxiety and depression in heart disease patients, compared with just receiving normal CR services alone.

CR services, whilst having an educational and exercise component, do not currently include any specific mental health treatment. After a serious cardiac event, such as a heart attack, it is common to develop mental health problems. Research shows that this type of distress reduces quality of life, and increases the risk of further heart problems and even death.

MCT helps people to manage worries and low mood through reducing unhelpful styles of thinking. It helps people to discover new and more helpful ways to react to negative or distressing thoughts so they are less likely to dwell on them, resulting in improved anxiety and mood.

Professor Adrian Wells, PATHWAY Chief Investigator said: “Through the generous time of patients, staff, co-investigators and service users in the NIHR-funded PATHWAY trial, we have made a breakthrough in improving mental health outcomes in cardiovascular disease.

Metacognitive therapy offers an effective way of treating both anxiety and depression. We found that cardiac patients benefited no matter whether they had mild or severe symptoms or a previous history of mental health issues, supporting the versatility of this treatment.”

Overall, there was an improvement in the mental health of one in three heart patients who received MCT alongside standard CR treatment, in comparison with only one in five of those who received standard CR treatment.  

The study was part of the portfolio of NIHR research managed by Clinical Research Network Greater Manchester, which supports the delivery of studies across a range of partner organisations, including all of the PATHWAY delivery sites.

Professor Kathryn Abel, NIHR Clinical Research Network National Specialty Lead for Mental Health, said: "Findings from this research are incredibly encouraging and present preliminary evidence that a psychological treatment may prevent development of common mental disorder in cardiovascular disease and be effective in reducing symptoms once developed in cardiac patients recovering from heart disease. Understanding the links between mental and physical disorders is an incredibly important aspect of the research endeavour for the NIHR mental health specialty and a priority for the Medical Research Council (MRC) mental health research framework.”

The link between mental and physical health has long been known, and these findings signal a major step in understanding and improving the overall recovery of heart disease patients.