Significance of psychosocial factors in cardiology-Update 2018. Position paper of the German Cardiac Society

Psychosocial factors in cardiovascular diseases are increasingly acknowledged by patients, healthcare providers and payer organizations. Due to the rapidly increasing body of evidence the German Society for Cardiology commissioned an update of its 2013 position paper on this topic. This position paper provides a synopsis of the state of knowledge regarding psychosocial factors in the most relevant cardiovascular diseases and gives recommendations with respect to their consideration in clinical practice. Psychosocial factors such as low socioeconomic status, acute and chronic stress, depression, anxiety and lack of social support are associated with an increased risk of diseases and an unfavorable prognosis. Psychosocial problems and mental comorbidities should be assessed routinely to initiate targeted diagnostics and treatment. For all patients, treatment should consider age and sex-specific differences as well as individual patient preferences. Multimodal treatment concepts should comprise education, physical exercise, motivational counselling and relaxation training or stress management. In cases of mental comorbidities, basic psychosomatic treatment and psychotherapeutic interventions by primary care providers or cardiologists, regular psychotherapy and/or medication should be offered. While these interventions have positive effects on psychological symptoms, robust evidence for possible effects on cardiac outcomes is still lacking. For coronary heart disease, chronic heart failure, arterial hypertension, and some arrhythmias there is robust evidence supporting the relevance of psychosocial factors, pointing to a need for considering them in cardiological care; however, there are still shortcomings in implementing psychosocial treatment and prognostic effects of psychotherapy and psychotropic drugs remain uncertain. There is a need for enhanced provider education and more treatment trials.