Dr Barbara Murphy, Director of Research, Heart Research Centre

Transcription

1 If patients don t know what to expect emotionally and don t get reassurance early, they are at risk of developing serious depression. This depression can last for a long time, often well beyond physical recovery. Once patients become depressed, they are more likely to have another heart event and to die early. Dr Barbara Murphy, Director of Research, Heart Research Centre

2 Coronary heart disease is a growing public health threat. Depression is a risk factor for the development and progression of heart disease and, in turn, heart disease confers an increased risk of mental health problems, including anxiety and depression. Acute cardiac events, such as acute myocardial infarction (AMI) and coronary artery bypass graft surgery (CABGS), trigger an emotional response for most patients. There is a growing awareness that cardiac patients need support in understanding the emotional aspects of their condition, and in assessing their depression risk and knowing when to seek help. Most people go on an emotional rollercoaster when they leave hospital after having a heart attack or heart surgery. They commonly feel shocked, fearful, traumatised, sad and anxious. Even those who have never been emotional become tearful, worried and insecure about their future. Patients find themselves in tears and experience ongoing struggles. Feelings of exasperation and mental exertion are also common. But there is also a common thread of hope and determination. Few people are prepared for the psychological changes that typically follow a cardiac event. They need help to understand what s happening to them emotionally, and how they are likely to feel once they get home. They need to be supported in their emotional recovery. In 2012, with support from beyondblue, we developed a range of written resources for patients designed specifically to help with emotional recovery the Cardiac Blues patient resources. These resources were developed with input from people who had recently had an acute cardiac event as well as health professionals working in cardiac rehabilitation. We know how important it is that health professionals are trained to support patients, which is why we also developed the Cardiac Blues health professional online training program. Health professionals can register to undertake the online training by ing us at cardiac.blues@heartresearchcentre.org or by going to the Heart Research Centre website The Cardiac Blues patient brochure titled getting back on track after heart attack or surgery can be given to patients individually, or can be used in group discussion such as in the cardiac rehabilitation setting. This manual outlines how you, as a health professional, can use the Cardiac Blues brochure with your patients

3 using the cardiac blues brochure Objectives of the Cardiac Blues brochure This guide is based on the evidence that psychological recovery is best achieved when an individual s emotional responses are acknowledged, normalised and responded to, when they understand the importance of dealing with emotions, and when they have strategies to assist them in dealing with emotions. Patients also need to know when and where to seek help. Steps in the Cardiac Blues brochure cardiacblues Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 O N T R A C K Outline likely emotional responses and accompanying symptoms Normalise these emotions and symptoms Talk to the patient about their emotions and behaviours Reassure that these emotions and symptoms are likely to resolve Alert patients to potential risks Check that patient has strategies for dealing with emotions Know your referral options

4 using the cardiac blues brochure Steps in the Cardiac Blues brochure with your patients O utline likely emotional response N T R A C K ormalise these emotions and symptoms alk to the patient about their emotions eassure that these emotions and symptoms mostly resolve lert patients to potential risks heck that patient has strategies for dealing with emotions now your referral options

5 introducing the cardiac blues brochure to the patient getting back on track after heart attack or surgery the ups and downs of emotional recovery cardiacblues cardiacblues

6 introducing the cardiac blues brochure to the patient Say to patient: It is very common after a heart attack/heart surgery to have a range of strong emotions and to find it difficult to adjust. I would like us to talk a bit about how you ve been feeling and look at some ways you can manage your mood and emotions. This brochure getting back on track after heart attack or surgery can help you on this emotional roller coaster. The brochure explains that: 1. It is very common and normal to have a range of emotions after a cardiac event. 2. Usually these symptoms resolve naturally over time. 3. There are some things you can do to help manage your emotions. 4. Sometimes there is a risk of serious depression after a cardiac event. 5. It is important to know when and where to seek help.

7 Step 1 Outline likely emotional responses and accompanying symptoms A heart event is an emotional experience, not just a physical one. Having a heart attack or heart surgery can come as a huge shock and can make you realise you re not immortal. Many people experience changes in mood and emotions after a cardiac event. Some people feel angry and irritable. Some feel sad and tearful. Some feel moody and up and down. Some people worry about whether they will ever get back to normal. When you leave hospital you may find yourself on an emotional rollercoaster. These feelings are all common and normal, especially in the first few weeks or months. normal emotional reactions to a heart event SHOCK You may find it hard to believe that you have a heart problem. DENIAL You might find it hard to accept that this has happened to you. WORRY You may worry that you will never get back to your old self. You might be fearful about dying. GUILT You may feel guilty about being dependent or blame yourself for what has happened. ANGER You may become frustrated and irritated about the changes in your life. SADNESS You may feel low and miserable, or your mood might be up and down. RELIEF You may feel relieved or thankful that your heart disease has been diagnosed and treated. Common symptoms that accompany these emotions include: Loss of interest in usual activities Withdrawal from others Getting tearful and crying easily Being short tempered Sleep problems Change in appetite Change in sex drive Confusion and forgetfulness Inability to concentrate Bad dreams and nightmares Worry about another heart event Thoughts about death A heart event can bring unwelcome changes. Panel 1 Panel 2 Panel 3

8 Step 1 Outline likely emotional responses and accompanying symptoms For this section, patients are given an opportunity to reflect upon the range of emotions that people commonly experience after a cardiac event and become aware of the symptoms that can accompany the emotional responses. Open to the first double page spread (panels 1 & 2) and the following page (panel 3). Panel 2 outlines the range of normal emotional responses and Panel 3 outlines the behavioural symptoms that commonly accompany these emotions. What to do: 1. Read out the first two statements A heart event is an emotional experience, not just a physical one. Having a heart attack/heart surgery can come as a huge shock and can make you realise you re not immortal. 2. Point to panels 3 (normal emotional reactions) and 4 (common symptoms) and go through both lists, mentioning that there is a range of emotions (eg. shock, denial, worry etc) and that these usually come hand in hand with a range of behaviours that patients might find difficult (eg. loss of interest in things you ve previously enjoyed, not wanting to see other people, being tearful etc). 3. Ask the patient to read through the list of normal emotional reactions (panel 2). 4. Ask the patient to read through the list of common symptoms that accompany these emotions (panel 3).

9 Step 2 Normalise these emotions and symptoms A heart event is an emotional experience, not just a physical one. Having a heart attack or heart surgery can come as a huge shock and can make you realise you re not immortal. Many people experience changes in mood and emotions after a cardiac event. Some people feel angry and irritable. Some feel sad and tearful. Some feel moody and up and down. Some people worry about whether they will ever get back to normal. When you leave hospital you may find yourself on an emotional rollercoaster. These feelings are all common and normal, especially in the first few weeks or months. normal emotional reactions to a heart event SHOCK You may find it hard to believe that you have a heart problem. DENIAL You might find it hard to accept that this has happened to you. WORRY You may worry that you will never get back to your old self. You might be fearful about dying. GUILT You may feel guilty about being dependent or blame yourself for what has happened. ANGER You may become frustrated and irritated about the changes in your life. SADNESS You may feel low and miserable, or your mood might be up and down. RELIEF You may feel relieved or thankful that your heart disease has been diagnosed and treated. Common symptoms that accompany these emotions include: Loss of interest in usual activities Withdrawal from others Getting tearful and crying easily Being short tempered Sleep problems Change in appetite Change in sex drive Confusion and forgetfulness Inability to concentrate Bad dreams and nightmares Worry about another heart event Thoughts about death A heart event can bring unwelcome changes. Panel 1 Panel 2 Panel 3

10 Step 2 Normalise these emotions and symptoms For this section, patients are encouraged to see these emotional responses and behavioural symptoms as part of the normal reactions to a cardiac event, and to understand that a cardiac event is an emotional experience, not just a physical one. What to do: 1. Highlight to the patient that these emotions and symptoms are normal and common. Point to the words normal and common in the two headings. 2. Emphasise that almost all cardiac patients experience some or all of these feelings and symptoms.

11 Step 3 Talk to the patient about their emotions and behaviours A heart event is an emotional experience, not just a physical one. Having a heart attack or heart surgery can come as a huge shock and can make you realise you re not immortal. Many people experience changes in mood and emotions after a cardiac event. Some people feel angry and irritable. Some feel sad and tearful. Some feel moody and up and down. Some people worry about whether they will ever get back to normal. When you leave hospital you may find yourself on an emotional rollercoaster. These feelings are all common and normal, especially in the first few weeks or months. normal emotional reactions to a heart event SHOCK You may find it hard to believe that you have a heart problem. DENIAL You might find it hard to accept that this has happened to you. WORRY You may worry that you will never get back to your old self. You might be fearful about dying. GUILT You may feel guilty about being dependent or blame yourself for what has happened. ANGER You may become frustrated and irritated about the changes in your life. SADNESS You may feel low and miserable, or your mood might be up and down. RELIEF You may feel relieved or thankful that your heart disease has been diagnosed and treated. Common symptoms that accompany these emotions include: Loss of interest in usual activities Withdrawal from others Getting tearful and crying easily Being short tempered Sleep problems Change in appetite Change in sex drive Confusion and forgetfulness Inability to concentrate Bad dreams and nightmares Worry about another heart event Thoughts about death A heart event can bring unwelcome changes. Panel 1 Panel 2 Panel 3

12 Step 3 Talk to the patient about their emotions and behaviours For this section, patients are asked identify their personal emotional responses and behavioural symptoms. What to do: 1. Looking at the list of normal emotional reactions (shock, denial etc panel 2) ask the patient to tell you which ones they relate to. 2. Encourage the patient to talk about their feelings. Prompt using can you tell me a bit more about that, how has that been for you etc. 3. Looking at the list of common symptoms that accompany these emotions (loss of interest, withdrawal etc panel 3) ask the patient to tell you which ones they relate to. 4. Encourage them to talk about their behavioural symptoms. Prompt using can you tell me a bit more about that, how has that been for you etc.