New Clinic Provides Mental Health Care for Patients With Heart Conditions

Kim Smolderen, PhD, professor of medicine (cardiovascular medicine) and of psychiatry, has dedicated much of her career to understanding the connection between mental health and cardiovascular health. There is a large evidence base supporting integrated offerings of psychological interventions along with their cardiovascular disease management for patients with various cardiovascular conditions; however, accessing these services remains challenging for many patients.

With her cardiology colleagues, Smolderen has recently started a new pilot program, the Yale Medicine Heart and Vascular Psychology and Wellbeing Clinic, to expand access and provide integrated psychological care for people with heart conditions.

“Mental health impacts the disease management of cardiovascular care in many ways, so it makes sense to treat them together,” says Smolderen. “We want to help patients rediscover what it means to thrive and experience well-being, even after a serious diagnosis.”

Through the pilot program, Smolderen cares for patients with various cardiovascular conditions. This includes people who have anxiety or depression following a heart attack, open-heart surgery, or a new cardiac diagnosis, and people who experience post-traumatic stress disorder or high anxiety following an implantable cardioverter defibrillator shock to their heart, or after surviving cardiac arrest, for example. Smolderen says the program also helps patients who want to make lifestyle changes, such as quitting smoking, developing routines for daily exercise, changing eating habits, or losing weight.

“While some patients will succeed in making lifestyle changes in a cardiac rehabilitation program, some patients will benefit from working one-on-one with a psychologist, where we can go deeper and offer interventions that focus on addressing the underlying issue of chronic and/or severe acute stress, all tailored to individual patients' needs,” says Smolderen. “My goal is to build resilience in patients so they have the coping skills to manage stress and help regulate their cardiovascular system.”

Interventions may include cognitive behavioral therapy, motivational interviewing, as well as mindfulness-based interventions. Smolderen also uses eye movement desensitization and reprocessing (EMDR), which is especially effective for patients dealing with trauma. Most interventions follow a protocol that includes a relatively brief intervention (for example, EMDR has eight phases), followed by recurrent assessment and additional therapy as needed.

Smolderen says she hopes this pilot program will also benefit cardiologists and other medical professionals who care for patients with cardiovascular issues.

“Many clinicians choose their profession because they have a calling. They want to help make people feel better and to cure people. Often, however, health care may be a revolving door, and many people seem to get sicker, which can diminish the original motivation for caring for patients,” says Smolderen. “By offering this clinic, we hope to give the patients extra time and support to tell their story and tend to their psychological needs so they might see a breakthrough they otherwise may not have seen. This method will benefit both patients and their doctors, who want their patients to experience the best possible outcomes from a holistic perspective.”

Over the next year, Smolderen and her team will assess how the pilot impacts patient health and outcomes. They will analyze referral data, emergency department visit rates, diagnoses of depression or anxiety, pain management therapies, and patient quality of life scores, among other data. She also wants to hear from patients and cardiology colleagues about their experience so that she can work with them to continue refining and improving the program.

"With more people receiving diagnoses of cardiovascular disease and mental health conditions, it is especially important to create a culture of collaboration between disciplines," she says. “I hope this program helps normalize integrated approaches for patients and clinicians. No single profession can address the whole person care.”