[Congressional Record Volume 143, Number 35 (Tuesday, March 18, 1997)]
[Extensions of Remarks]
[Pages E494-E495]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             HEART DISEASE

                                 ______
                                 

                           HON. MARCY KAPTUR

                                of ohio

                    in the house of representatives

                        Tuesday, March 18, 1997

  Ms. KAPTUR. Mr. Speaker, several months ago I was pleased to 
cosponsor a congressional briefing addressing the important health 
issue of heart disease. Those who attended this event had the privilege 
to listen to four distinguished specialists in the area of heart 
disease discuss the important benefits of psychological intervention in 
the care of patients with heart disease.
  The speakers were: Dorothy W. Cantor, Psy.D., president, the American 
Psychological Association; Ernest H. Johnson, Ph.D., director, 
behavioral medicine research, Morehouse School of Medicine; Wayne M. 
Sotile, Ph.D., director, psychological services, cardiac rehabilitation 
program, Wake Forest University; and Redford B. Williams, M.D., 
director, Behavioral Medicine Research Center, Duke University.
  Each day in America, 4,000 people suffer a heart attack--one in five 
before age 60. Five million Americans have coronary heart disease 
[CHD], and approximately 400,000 of these individuals each year suffer 
heart failure. Some 70 percent of the victims of an initial heart 
attack and 50 percent of individuals who suffer a recurrent heart 
attack survive. As medical treatment for heart patients improves, a 
growing number of heart attack survivors are younger than age 65. 
Nearly 2.5 million Americans have some degree of vocational disability 
or limitation caused by heart illness. CHD is the leading problem for 
which patients receive premature disability benefits.
  Between 50 and 60 percent of all caridac patients who enter the 
hospital experience elevated levels of depression, anxiety, and fear. 
Depression is one of the factors which predicts mortality from heart 
illness and recurrence of a heart attack. Over 50 percent of spouses 
and children of caridac patients experience elevated stress, anxiety, 
and somatic preoccupation for up to 10 years following a loved one's 
heart illness. Family tensions and social isolation have been shown to 
be significant risk factors for recovering heart patients.
  Research shows that psychological intervention leads to shorter 
hospital stays, reduced rehospitalization, and reduced rates of 
recurring heart attacks and death. In fact, as little as 30 minutes of 
psychological counseling per day for 5-6 days has been shown to lead to 
discharge from the hospital 2.5 days sooner and from the intensive care 
unit 1 day sooner, as well as lessening morbidity.
  The Clinical Practice Guideline for Caridac Rehabilitation recently 
published by the U.S. Department of Health and Human Services 
emphasized that education alone is not effective in helping heart 
patients cope. Effective intervention combines education, counseling-
providing advice, support and consultation-and behavioral 
interventions--systematic instruction in techniques to modify health 
related behavior.
  Unfortunately only 12 percent of formal cardiac care programs utilize 
consultation from a psychologist.
  Summary information on the briefing follows:

                           Information Sheet

       Each day in America, 4,000 people suffer a heart attack--
     one in five before age 60. Five million Americans have 
     coronary heart disease (CHD). Of these, approximately 400,000 
     suffer heart failure each year in the United States. Seventy 
     percent of victims of an initial heart attack and 50 percent 
     of individuals who suffer a recurrent heart attack survive. 
     As medical treatment for heart patients improves, a growing 
     number of heart attack survivors are younger than age 65. But 
     nearly 2.5 million Americans have some degree of vocational 
     disability or limitation caused by heart illness and in the 
     United States, CHD is the leading problem for which patients 
     receive premature disability benefits.


        Why Is Psychological Care Important For Heart Patients?

       Immediately following heart surgery there is a window of 
     opportunity in which to educate recovering heart patients 
     about adaptive coping skills. The Information patients are 
     given in this time period shapes their thinking about life 
     after heart surgery for up to five years. For instance, if 
     patients believe they cannot have sexual relations, or cannot 
     exercise, and are not told differently, they may hamper their 
     recovery.
       Incorporating psychological intervention into the care of 
     recovering heart patients is important because:
       Between 50 and 60 percent of all cardiac patients who enter 
     the hospital experience elevated levels of depression, 
     anxiety or fear.
       Over 50 percent of spouses and children of cardiac patients 
     elevate on measures of stress, anxiety and somatic 
     preoccupation for up to ten years following a loved one's 
     heart illness.
       A significant percentage of recovering cardiopulmonary 
     patients and their families experience frustration about 
     feeling ill-prepared for the long-range course of 
     rehabilitation.
       Family tensions and social isolation have been shown to be 
     significant risk factors for recovering heart patients.
       Depresssion, social isolation and hostility predict 
     mortality from heart illness and recurrence of a heart 
     attack.


          Psychological Interventions Make a Proven Difference

       Reserach shows that:
       As little as 30 minutes of psychological counseling per day 
     for 5-6 days has been shown to lead to discharge from the 
     hospital 2.5 days sooner and from the Intensive Care Unit one 
     day sooner, as well as lessening morbidity.
       Group therapy with recovering heart attack patients has 
     consistently been found to improve measures of psychological 
     well-being and lessen indicators of morbidity throughout the 
     first three years of recovery.
       Two hours of psychological counseling per week for seven 
     weeks has been shown to reduce incidence of re-
     hospitalization for recovering heart attack patients by 60 
     percent.
       Treatment of depression has been shown to reduce rates of 
     re-occurring heart attacks and death over three years of 
     follow-up.
       A single supportive interview delivered on the evening 
     before surgery has shown to lessen post-operative psychosis.

[[Page E495]]

       Brief psychological counseling prior to medical or surgical 
     intervention has been found to produce shorter stays in the 
     Critical Care Unit, less emotional distress, fewer 
     arrhythmias and shorter hospital stays when compared to 
     routine CCU care.
       Three sessions of psychological counseling in two days 
     prior to catheterization can significantly improve patient 
     management of the stress of the procedure.
       Relaxation training diminishes post-surgical incidence of 
     delirium, medical complications and lengths of hospital stay.


                        Education is Not Enough!

       The Clinical Practice Guideline for Cardiac Rehabilitation 
     recently published by the U.S. Department of Health and Human 
     Services emphasizes that education alone is not effective in 
     helping heart patients cope. Effective intervention combines 
     education, counseling (providing advice, support and 
     consultation), and behavioral interventions (systematic 
     instruction in techniques to modify health related 
     behaviors). Such combination treatments have been shown to: 
     Reduce symptoms of angina in recovering CHD populations; 
     promote stress management and overall psychological well-
     being in recovering cardiac populations; increase the rate of 
     smoking cessation in recovering cardiac patients by 
     approximately 18 percent compared to rates of spontaneous 
     smoking cessation; significantly enhance modification of diet 
     to lower lipids and lower body weight; lower blood pressure, 
     when added to a comprehensive rehabilitation program.
       Research has shown that education, counseling and 
     behavioral intervention designed to encourage heart patients 
     to adhere to therapies have been associated with: Reduction 
     in recurrent coronary event rates; regression of 
     atherosclerosis; reduction in cardiac and overall mortality 
     rates.


            What Do Psychologists Do To Help Heart Patients?

       Enhance self-management skills and self-efficacy.
       Reduce psychophysiological arousal with relaxation training 
     and biofeedback.
       Alter specific behavior patterns through stress management.
       Enhance social support.
       Identify patients who are at high risk.
       Diminish resistance to healthy lifestyles.
       Develop effective conflict resolution strategies.


       What Is Currently Being Done to Help Heart Patients Cope?

       Unfortunately only 12 percent of formal cardiac care 
     programs utilize consultation from a psychologist.

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