Evidence-Based Treatment of Emotional Distress in Patients with Ischemic Coronary Heart Disease

Replicated gold-standard evidence (ie, randomly assigned, controlled clinical trials) demonstrates that cognitive-behavioral therapy targeting AIAI (aggravation, irritation, anger, and impatience) reduces “hard” event (eg, myocardial infarction, death) rates. Symptoms and costs also improve in patients with ischemic coronary heart disease who are treated for emotional distress. Nevertheless, routine care for these patients generally ignores these cost-effective strategies. Anxiety, and perhaps depression, may also be pathogenic for cardiovascular events and are important for symptom control (eg, ischemic or noncardiac chest pain, palpitations, presyncope, fatigue). The pressure on cardiac care practitioners to document actual clinical benefits to patients for expended health care dollars should induce them to take a new look at emotional distress in patients with ischemic coronary heart disease and the benefits of treatment. [ Psychiatr Ann . 2016;46(12):677–682.]