From Guidelines to Practice: Comparing Italian Cardiologists’ and Patients’ Perceptions of Psychological Support in Cardiovascular Care

Psychological factors (depression, anxiety, chronic stress) and related vulnerabilities (e.g., maladaptive coping, emotion dysregulation, social isolation) are common in cardiovascular disease (CVD) and are associated with worse prognosis, adherence, rehospitalizations, rehabilitation outcomes and quality of life. ESC guidance recommends integrated, multidisciplinary care including psychologists to strengthen risk assessment, patient engagement and health–behavior change, yet implementation in routine care remains limited. We compared cardiologists’ and patients’ perceptions of the utility of psychology/psychologists in cardiac care. National cross–sectional anonymous online survey of Italian ANMCO cardiologists and adults (≥18 years) with a CVD diagnosed recruited via a patient advocacy organisation. Parallel ad hoc items assessed knowledge/attitudes, prior psychological involvement/collaboration and barriers. Both groups completed the “Attitudes Toward Seeking Professional Psychological Help Scale–Short Form” (ATSPPHS–SF) and the “Marlowe–Crowne Social Desirability Scale short form”. N=436 (218 patients; 218 cardiologists). Patients were older (66.69±10.27 vs 53.97±13.81 years, p‹.001) and reported lower perceived psychological utility (69.59±13.93 vs 82.78±11.31, p‹.001), fewer psychological involvements (4.98±1.36 vs 6.92±1.37, p‹.001) and less positive help–seeking attitudes (ATSPPHS–SF 17.93±6.00 vs 21.07±5.39, p‹.001) than cardiologists; social desirability was slightly higher (22.06±2.17 vs 21.32±2.43, p=.001). Cardiologists rated higher the usefulness of training on psychological/cognitive factors in CVD (5.76±1.34 vs 5.39±1.58, p=.009), physician–patient relationship dynamics (6.11±1.27 vs 5.67±1.51, p=.001), and psychologist involvement in selected clinical communications (5.85±1.39 vs 5.26±1.72, p‹.001). Notably, 70.2% of patients had never received information on psychological factors in CVD. Among those reporting unmet need, main barriers were lack of information on services (34.0%) and economic constraints (32.0%). Cardiologists appear more supportive of psychological care than patients; improving patient information, affordability and clear referral pathways, alongside low–threshold/step–care options (including telepsychology), may enhance uptake and align practice with ESC recommendations. Embedding brief psychosocial screening and shared decision–making in cardiology visits may further reduce disengagement.