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This on-demand webinar will explore the relationship between cardiovascular disease and mental health and will address issues such as risk factors and risk markers, common physiological mechanisms, and underlying determinants of health. It will feature the British Heart Foundation’s research on the emotional effects of having a heart condition, and will discuss how major depression and cardiovascular disease are linked to increased mortality rates. The presenter, Joanne Horse, is a nurse, independent nurse consultant, and clinical director for Learn with nurses. She will explore the chicken and egg relationship between cardiovascular disease and depression, as well as share her research on the attitudes and beliefs of healthcare professionals regarding depression and heart attack prognosis.
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This session will explore the relationship between cardiovascular disease and mental health and the impact this can have on individuals, along with practical information that can help support them and improve outcomes.

Intended Learning Outcomes:

  • To be aware of the relationship between cardiovascular disease and mental health
  • To appreciate the impact of this on individuals and the population
  • To be familiar with practical information that can help support people with co-existing cardiovascular disease and depression and improve their health outcomes

Joanne Haws is a registered nurse who held a variety of roles within the UK NHS before setting up in business as an independent consultant in 2010.  Joanne is the Clinical Director of Learn With Nurses, a Community Interest Company providing online clinical education that is accessible to healthcare professionals globally. She is a member of the Nurses and Allied Health Professionals Working Party of The British and Irish Hypertension Society and has authored many publications in the nursing and cardiology press both in the UK and internationally.  Joanne is a Non-Executive Director of the National Association of Primary Care (NAPC) and is a facilitator on the CARE programme. She has been a Specialist Advisor to the Care Quality Commission since 2014.

Learning objectives

Learning Objectives: 1. Identify the link between cardiovascular disease and mental health. 2. Explain the ways that mental health issues affect people suffering with cardiovascular disease. 3. Describe the emotional effects of having a heart condition. 4. Discuss the shared physiological mechanisms between cardiovascular disease and mental health. 5. Explain the attitudes and beliefs of healthcare professionals towards depression in relation to cardiac health.
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Computer generated transcript

The following transcript was generated automatically from the content and has not been checked or corrected manually.

Good evening and a very warm welcome to this, see, three, collaborating for health webinar on cardiovascular disease and mental health. My name is Joanne Horse. I'm a nurse, uh an independent nurse consultant. Uh I'm also the clinical director for Learn with nurses and I do a number of other jobs including I'm a non executive director for the National Association for Primary Care. And I've been asked to do this session live this evening. So welcome to everyone that's joining me live. But also, hello, if you're watching this at a later date on catch up, those of you who are with me live this evening will be able to uh put any messages, ask any questions in the live chat box. Now, if you are watching on demand, you won't be able to see those questions. So I will read anything out as it comes along to make sure that you don't miss out on any extras. So to start with, I'm just going to tell you a little bit about C three collaborating for health in case you're quite new to the organization and see three have this in credible vision of a world where there are no preventable deaths from non communicable diseases because people find it easier to live healthy lives. And we all know that the right thing to do happens if it is an easier option for people to follow. And that's not always the case. So the business really is on prevention and why is this important? Well, the World Health Organization have identified three risk factors, the use of tobacco, a lack of physical activity and the food and drink that we take into our bodies. If we make less healthy choices, these three risk factors can lead to the 44 of the key chronic diseases that are accountable for 70% of the disease burden worldwide. So we're talking about all of the cardiovascular diseases, type two diabetes, many cancers and chronic lung disease. Now, I've been a part of this fabulous project um with the three collaborating for health. It's a partnership with the Burdick Trust to address smoking in mental health units here in England. Now, we know that people with a mental health condition are much more likely than other people without any mental health problems to be smokers. In fact, we know that over 40% of people with a mental health condition are active smokers compared to 14% in the general population. And this does unfortunately put this population at a much higher risk of heart disease. So as part of the winning hearts and minds project, we have some training, education and other things available. So you may have caught my good pal and colleague Michaela Nuttall delivering one of these webinars on smoking, but specifically looking at just how does smoking cause blockages in arteries. If you miss that one, you can find it on catch up. There's going to be a suite of these things available for you to be able to catch up on this evening talking about mental health and cardiovascular disease. We have a session of motivational interviewing. We've got a quiz and there's also going to be a round table event. Now, I must just say, excuse that little background noise. I am coming to you from my home this evening and one of my dogs is doing his party trick of going to have a really big drink whilst I'm presenting. So if you can hear lots of water moving around, that's my boy having a little drink there. So, apologies if that's distracting, but let's talk about cardiovascular disease and mental health. Now, I'm really going to be focusing on depression and anxiety being really the most common issues that so many people are facing on a daily basis. But the relationship between cardiovascular disease and mental health really does go across the board and we know people with severe mental illness, people who are suffering with post traumatic stress disorder, other stress disorders all come into this unfortunate category of being at higher risk of cardiovascular disease. And there is a two way relationship between the two that I'll explore a little bit further as we go on. But first, let's have a look at some numbers. Now, almost half of all patient's who have a myocardial infarction or heart attack will develop depression following on from their event. And about one in five people who are attending for an outpatient appointments in relation to coronary heart disease are suffering with depression. Now, perhaps unsurprisingly, there is a very high prevalence of depression in people who are living with heart failure and people who have had a stroke. And as I mentioned, people with serious mental illness generally have an increased risk of cardiovascular disease and the uh presence of cardiovascular disease and particularly with depression in cardiovascular disease can be a really strong predictor of morbidity and of mortality. Now, if we look at some information from the British Heart Foundation around the emotional effects of having a heart condition, we can see perhaps why these figures are so prominent. So the vast majority over three quarters of people who have experienced a heart condition or a problem have felt anxious, which is perhaps not surprising. Over half of people have felt low, depressed or tearful. A third feeling upset, almost a half people feeling scared. One in five feeling isolated, 38% feeling that others just didn't understand what's going on. And one in five people feel like a different person once they have been diagnosed with a heart condition, many struggling to socialize and even struggling to get out of bed in the morning. And of course, it's not only affecting the individual themselves that has the heart condition, but it's their loved ones, those around them work, colleagues, family friends, everybody can be affected by this. And I've done work in cardiac rehabilitation and in acute cardiology and long term care of patient's with cardiovascular disease in primary care. And often it will be the relatives, wives, husbands and Children that say they just don't see the say seem to be the same person following on from this heart attack. So there is a massive psychosocial emotional burden of having a heart condition. And this really does impact on mortality. And there's a, a study that was done a number of years now, but this figure was just so stark that I had to include it. And I really don't know how much better things are today, but people who have major depression and that is quite a lot of people can be up to a third of people having severe depression following a heart attack five times more likely to die within six months of their event than those who are not depressed. And this doesn't necessarily seem to be linked to some of the key physical factors that would sort of be markers of the severity of the disease. So, not necessarily uh related to people having ongoing E C G changes to the functionality of the heart following the cardiovascular event. So it seems that there's something very much more going on here than the reaction to the event itself and the relationship between cardiovascular disease and depression could really be described as a bit chicken and egg. Um, but there are lots of shared factors, there, some really interesting connections and in truth, we don't have the full picture, we don't really fully understand what's going on. So we know people can have an emotional um a psychological response to having any sort of adverse health event, which is completely understandable, particularly when it is a life threatening or potentially life threatening event, such as a heart attack can also be a marker of risk in that often there are unhealthier behaviors that we know are culprits when it comes to cardiovascular disease, which also are often more prevalent in people who are suffering with depression, anxiety or other mental health conditions and problems. So really said that people are far more likely to smoke but are less likely to be physically active, more likely to make unhealthier food choices or have less access to healthier choices and perhaps be less likely to make those positive changes in their lifestyle behaviors that could improve their overall health and well being and reduce their cardiovascular risk. So there's a real relationship there between risk factors and risk markers. But we know that there's also some shared underlying physiological mechanisms between both conditions and I guess this leads us to that saying of what's what's good for the heart is good for the mind because there are these really common factors shared between both. So we all know that inflammation is the root cause of all evil. So, inflammatory, systemic inflammation, inflammatory conditions often coexist within cardiovascular disease and inflammatory markers are often raised in both cardiovascular diseases and also metabolic conditions and also in mental health conditions as well. We understand the issue of serotonin disregulation very much when it comes to mental health, but less recognized in physical health conditions, particularly in cardiovascular disease as well. And we also see a reduction in omega three fatty acids, which we also know are really beneficial factors when it comes to protecting against cardiovascular disease. So there's lots of stuff going on underneath these issues that connect the two and the impact that we see of anxiety and depression in people with cardiovascular disease is absolutely multifactorial. Now, I'm really interested in those wider determinants of health. And I really don't think that we can. Well, I know we can't separate out, separate out people's physical health from their psychological health and well being. And it's where these meet that we see that there is a huge impact but also the potential for some really helpful interventions and activities. So people with cardiovascular disease are likely if they're suffering with depression and or anxiety to have a much for a quality of life as you might expect we've already talked about the increased risk of death, but there's increased risk of spending more time in hospital, certainly more primary care consultations and overall uh less adherence to treatments. Now be that in terms of medications or in terms of the motivation, the ability to be able to make and stick to lifestyle changes that could improve their cardiovascular risk profile and that overall quality of life health and well being. There's an impact on productivity of being able to return to work and taking a full and active part in society that impact on family life. I mentioned earlier about sometimes people's partners and family members can really see that change and that has a huge impact on people's circumstances, financial difficulties from being less able to work, but also perhaps indulging in less healthy and perhaps more financially demanding activities. All of these can really result in a much poorer quality of life for individuals and as healthcare professionals, we don't always have the best grip of this relationship between what's going on in the heart and what's going on in the mind. Now, some years ago, now I did my MSC research looking at the the attitudes and beliefs of primary healthcare professionals towards depression after my cardio infarction, knowing that this is a big problem that affects so many people and has a huge impact on outcomes and surveyed a large number of GPS and general practice nurses across the country asking them all sorts of stuff about the impact relationship, diagnosis, treatments, etcetera, etcetera. And generally, everyone agreed that depression would have a negative impact on people's prognosis, their adherence to treatment, whether or not they participated in cardiac rehab and whether they would go on and have further cardiovascular events. Um but there were some key differences and we did find that many primary care nurses felt that it was really not a straightforward thing, something that they really weren't trained, particularly to us to assess and to manage or even that it was necessarily part of their roles or really sort of felt conversant with the protocols and the guidance around these things. And GPS overall felt much better equipped and we're more likely to have had training on dealing with this kind of thing rather than nursing teams. And we know that nursing teams are often heavily involved in supporting patient's and that long term follow up and preventative work for patient's with coronary heart disease. So it felt like there was, you know, much more that could be done in, in terms of support and education for healthcare professionals um in this particular area where patient's were being managed for their cardiovascular disease and thinking about the impact of depression on this. And we talked about the use of the brief screening tools that we have for depression anxiety and these two questions, tests that people often struggled with. They felt it could be opening cans of worms. Uh They're often wasn't time to address these issues. And if we did identify they're being a problem, what do we do next? Uh Some people felt that it was a bit pointless asking these questions, but these are validated tools, these brief screening tools for depression anxiety and can certainly give you a good marker that would then obviously, if you get a positive response would need to be followed up by a more in depth screening tool to be able to make a fuller assessment on the individual and what might be helpful uh in terms of next steps for that person, in terms of um interventions and support. And sometimes it can be about asking the right questions alongside this formal assessment to be able to really see how somebody is doing. Um finding out how they're sleeping, whether they are a smoker, what their social circumstances are like, how they're getting on with their medication when it comes to adherence to medication and all medications. We often ask people if they take their tablets two, which I often feel the stock response is going to be a yes. Certainly. It's my response when I'm asked about, do you take all your tablets? And I say yes, but in reality, I do often forget now that's um you know, something I'm not deliberately choosing to do. I'm just not very good, particularly on the weekends at remembering to take my medication. But of course, people may have chosen their intentional nonadherence to, you know, chosen not to take their medication. And, and I think it's important that we give people permission to be honest about what they're doing in terms of their treatments and whether or not they're taking their medication, whether they're doing the things that have been recommended for them and whatever. And so we can really, you know, here from the individual about whether or not this is working for them. And is there anything that could be done differently that might be more acceptable, more effective for them? And part of that might be around their beliefs around their condition, um Whether it's important to them because often we, it could be assumed, uh many of us can be guilty of this, of assuming certainly when it comes to something like cardiovascular disease, that of course, it's going to be the most important thing to the world to somebody that they stop smoking, that they get their BP down, that they reduce their cholesterol and all things like that. But if, if people are really suffering with mental health problems, then this may not be anywhere near the top of their priority list. Likewise, thinking about those wider determinants of health. If people have poor housing or perhaps even know housing, if people are having difficult family circumstances, if they're facing bereavement, or if they've got huge financial worries, uh There are all manner of things that we have in our lives that are priorities at the time. And sometimes the things that everyone else might assume to be our priorities just aren't really up there. Um Or sometimes we might really struggle to understand the significance of these health problems that we may have. So it just might not be that important. And there's also something there around confident, whether somebody feels confident that they are going to be able to manage their health, whether they're going to be able to address their health need, needs any treatment regimes, any interventions. And just generally, whether they feel able and equipped to be able to deal with this. And you know, is there anything else that we can do to help support them or maybe this just isn't the right time to be addressing some of these issues. We know that there are really effective treatments available for anxiety and depression. And we know that these are also safe and effective for use in the presence of cardiovascular disease. One of the most effective treatments here being exercise. Um But again, people have got to be able to want to feel motivated to physically able to take literally those steps to be able to do that. But that's something that should be freely accessible to everybody who is able um to do that and most of us can move something. Um We have specific disease management programs. I've mentioned cardiac rehab. There are other specific disease management programs around um diabetes and other things that may be very helpful for people. We have psychological therapies and we also have medications of course. And generally the SSRI S are perfectly safe to be used in the presence of cardiovascular disease. That used to be a big concern around uh the use of antidepressant medication in people who had heart problems. But predominantly that was sort of the older tricyclic type antidepressants. But we're all good for using the newer types and they can be very effective in helping people and enabling them to deal with their condition. That can certainly be helpful in terms of their outcome. The kind of things that people can find helpful. Now, I tend to steer clear too much of that. The A word, the advice word because advice very much feels like telling somebody what to do. And of course, none of us like to be told what to do. But what people can find helpful are things like getting dressed every day and not lounging around in your pajamas though. I do quite like to do that given the opportunity, getting outside, having a little walk, practicing relaxation techniques, trying to get back to any hobbies or any social activities that they enjoy or have enjoyed in the past. Talking, share ing how they're feeling be that with friends, colleagues, people in other social search situations or healthcare professionals eating well balanced meals and trying to get some, some good nutrition in can make the world of difference to how we feel as can having a good night's sleep. And that can be a really struggle whether you have cardiovascular disease, mental health problems, particularly if you have both. So we could let people know about any kind of support groups that might be available locally that they could perhaps consider and it needn't necessarily be a specific health type group. Um It might just be something social that's available locally that they might be able to tap into and where possible, avoiding those harmful habits that so many of us can often use as coping strategies which inevitably end up making the problem worse. But of course, all these things are very often much easier said than done. But if there are one or two things that people may be able to pick out there and give it a whirl, they may well find that this is helpful to them and thinking about family members in terms of practicalities, it can be really helpful for them to know that this is common and that their loved one can't help this, what's going on at the moment. It's, it's not a weakness, it's not a failure. It is something that is very, very common in the population and any help and support that they can give is going to be really helpful in terms of following their treatment plan. And ideally, if this can be consistent, even if you are being rejected, just being there and maintaining that support could be really helpful. However, what we don't want to do is to be wrapping people up in cotton world moloch coddling whatever you would like to call that because people need to feel empowered and be empowered. This is, this is them, this is their body, their health, their life and they are absolutely in charge of this. So anything that we can do to help people feel and take charge of this condition can only be a good thing. And it's important to take breaks from each other and it can be really difficult to do that. If you are a relative who is scared, something terrible is going to happen, it can be really difficult and you can have a tendency to want to watch somebody constantly to make sure that they're okay. But, you know, sometimes this isn't the best thing and sometimes people are going to need professional help with this and that's okay. And maybe you yourself might need some help with this. If it's a family member that's going through this and the support groups and patient groups that are out there aren't, of course, just for the individual that suffering with the condition, they can be very helpful to patient's and relatives as well. So there's lots that people can do to be helpful. So hopefully that um has been helpful in giving some uh food for thought for you about cardiovascular disease and mental health and the relationship between the two and, and quite how much they can impact on each other and the impact that they can have on patients' outcomes in terms of morbidity, mortality, but their overall quality of life, health and well being as well. And there's lots that we can do as healthcare professionals to try and help people to make things a bit better and certainly give them some information on what other people in similar circumstances, often find helpful and information for family members as well on how they can help, but also how they can get some support for themselves. So I'm very happy to take any questions if you have them. Now, for those of you who are on the live session right now, I have just popped a link in the chat to the feedback form. So if you would be able to complete that if you're watching on demand, it may just pop up afterwards or you might get an email afterwards that will take you to that. So if you could complete that, that would be really helpful for us for planning future sessions, you will get a certificate of attendance that will be available through medal and this webinar will also be available on demand also through medals. So if you found it helpful or if you want to go back and revisit everything, anything, then please do or otherwise feel free to tell your mates. I can't see any questions coming through as yet. So I will look at my clock and see what the time is. We are a couple of minutes before we need to wrap up. But if we don't see anything coming in, then I will give you five minutes of your evening back um to hopefully do something to help your own mental health. Um and well being so thank you so much for joining me. It's been great to have you with me and do look out for further events and resources that are available to support this winning hearts and minds project and do keep a lookout for what else is going on with C three, collaborating for health. But for now from me, take care, stay safe and have a lovely rest of your evening. Thanks very much. Bye bye. Okay.