Short summary

Approximately 20% of patients with ischemic heart disease develop anxiety and/or depression, hence, systematic screening as part of cardiac rehabilitation has been recommended in clinical guidelines in Denmark since 2013. We conducted a longitudinal study to follow the implementation in real-world practice. We found substantial improvements in both hospitals and municipalities, but there is still room for improvement. The study point to factors supporting implementation in practice.

Rationale

Approximately 20% of patients with ischemic heart disease develop anxiety and/or depression. Anxiety and depression can be detected by screening, improving the possibility to initiate treatment. Accordingly, systematic screening has been recommended as a core component of cardiac rehabilitation in clinical guidelines in Denmark since 2013. However, the litterature suggest that the implementation of screening in practice may be slow, and little is known about factors supporting and hindering implementation. Accordintly, we set out to follow the dissemination and implementation of systematic screening in hospitals and municipalities over a seven-year period.

The study assessed, over time, adherence to clinical guideline recommendations of systematic screening and use of a validated screening tool, the proportion of screened patients, and the healthcare professionals experiences of factors that helped and hindered implementation.

Description of the cohort

Danish hospital departments providing cardiac rehabilitation (n varying from 36 to 32 due to reorganizations) and all municipalities (n=98).

Ischemic heart patients participating in cardiac rehabilitation programmes in these hospitals and in municipalities in the Central Denmark Region.

Healthcare professionals (nurses, physiotherapists) providing cardiac rehabilitation in hospitals and municipalities.

Data and biological material

Programme level data were obtained from questionnaire data collected from national surveys of programme level cardiac rehabilitation in 2013, 2015 and 2018 (variables of interest included screening on a programme level, and screening tool).

Individual patient level data were retrieved from the annual reports of the Danish Cardiac Rehabilitation Database and the The Danish Database for Cardiac Rehabilitation in Primary Health Care Setting (HjerteKom Database), to assess the proportion of screened patients. The annual reports are publicly available.

To study screening practices and the barriers and facilitators for implementation, we conducted semi-structured interviews with n=11 (2015) and N=11 (2020) healthcare professionals.

Collaborating researchers and departments

Professionshøjskolen Metropol

• Pia Munkehøj

The Heart Foundation

• Stig Brøndum

Dept. of Psychology, Odense University Hospital

• Susanne S. Pedersen

Dept. of Cardiology, Zealand University Hospital

• Lotte Helmark

REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark

• Ann-Dorthe Zwisler
• Henriette Knold Rossau

Publications associated with the project

Egholm, C. L., Helmark, C., Rossau, H. K., Munkehøj, P., Brøndum, S., Pedersen, S. S., & Zwisler, A-D. (2022). Implementation of systematic screening for anxiety and depression in cardiac rehabilitation: Real world lessons from a longitudinal study. Journal of Psychosomatic Research, 158, [110909]. https://doi.org/10.1016/j.jpsychores.2022.110909