Johnsson, Amanda (A);Ljótsson, Brjánn (B);Liliequist, Björn E (BE);Skúladóttir, Helga (H);Maurex, Linnea (L);Boberg, Ida (I);Ólafsdóttir, Eva (E);Klavebäck, Sofia (S);Braunschweig, Frieder (F);Mellbin, Linda G (LG);Särnholm, Josefin (J);

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Eur Heart J Open.2025 Mar 07;5(2):oeaf020.doi:10.1093/ehjopen/oeaf020

Abstract

AIMS: Cardiac anxiety, which is cardiac-related fear and avoidance behaviours, is common following myocardial infarction (MI) and has been associated with increased risk for cardiovascular events. However, there are currently no treatments specifically designed to target cardiac anxiety. The aim of the two pilot studies was to evaluate an exposure-based cognitive behavioural therapy protocol (MI-CBT) targeting cardiac anxiety following MI, assessing feasibility, acceptability, and the intervention's potential for reducing cardiac anxiety and improving health-related quality of life (QoL).

METHODS AND RESULTS: A series of two sequential, uncontrolled pilot studies were conducted. In Pilot Study 1 ( = 15), MI-CBT was delivered via face-to-face videoconference, while Pilot Study 2 ( = 23) was delivered online. Patients with a history of MI (≥6 months before assessment, type 1 ST- or non-ST-segment elevation MI, and elevated cardiac anxiety as per clinical interview) were included. The interventions lasted 8 weeks and were therapist-led, with key components including exposure to cardiac-related symptoms and reduction of avoidance behaviours. Participants completed self-rated assessments, including the Cardiac Anxiety Questionnaire (CAQ) and the 12-Item Short Form Health Survey (SF-12), at baseline, post-treatment, and 6-month follow-up. Treatment adherence and satisfaction were high. Cognitive behavioural therapy led to a large reduction in cardiac anxiety, as measured by the CAQ ( < 0.001), and significant improvements in health-related QoL, as measured by the SF-12 ( < 0.001), in both pilot studies.

CONCLUSION: These studies suggest that exposure-based CBT is a feasible, acceptable, and promising approach to reduce cardiac anxiety and improve QoL following MI. A randomized controlled trial should be conducted to evaluate the efficacy of the intervention.