Implementing a stepped-care psychological pathway for cardiac patients with comorbid anxiety and depression in the UK: a service development project

Background/aims This was a pilot study that was part of a Department of Health and Social Care initiative to improve access to cognitive behavioural therapies for patients with long-term health conditions. The service development work involved integrating an ‘Improving Access to Psychological Therapies’ service with a cardiac rehabilitation service, to treat patients with cardiac disease and comorbid anxiety and/or depression. The aim was to reduce levels of anxiety and depression, urgent care visits, inpatient stays and outpatient appointments, and secondary care service usage. Methods A repeated-measures design was implemented using clinical data collected as part of routine practice. A quasi-control group was used for the economic evaluation, comparing patients who entered into therapy with those who did not. Collaboration between an Improving Access to Psychological Therapies and cardiac rehabilitation service identified 222 cardiac patients (142 males; 80 females) with comorbid anxiety and/or depression to access the pathway over 29 months. Patients accessed psychological therapy using the Improving Access to Psychological Therapies stepped-care model, where therapy intensity and durations varied according to patient need and complexity. Psychological outcomes were measured at three time points: assessment; end of contact; and 3-month follow up. Secondary care service usage was measured for 6 months before and after therapy. Results Significant improvements on all psychological outcomes were found when comparing scores between the three time points. Patients with coronary heart disease and myocardial infarction who received Improving Access to Psychological Therapies treatments had decreased use of secondary care hospital services. Conclusions An integrated Improving Access to Psychological Therapies and cardiac rehabilitation service can provide effective, adapted evidence-based psychological treatments for cardiac patients with comorbid anxiety and depression.