A digital, exposure-based cognitive behavioral therapy (CBT) intervention is beneficial for cardiac anxiety in patients after myocardial infarction, according to randomized trial results published online March 25 in the Journal of the American College of Cardiology and an accompanying study detailing the methods published in JACC: Advances.
Amanda Johnsson, from Karolinska Institutet in Stockholm, and colleagues applied an exposure-based CBT approach for cardiac anxiety in patients after myocardial infarction. The randomized controlled trial assessed the efficacy of a therapist-guided, digital exposure-based CBT intervention for cardiac anxiety (CA-CBT), which was delivered digitally over eight weeks, compared with usual care.
Ninety-six participants were randomly assigned to receive CA-CBT or usual care (48 to each group). The researchers found that compared with usual care, CA-CBT led to significant improvements on the Seattle Angina Questionnaire (SAQ) quality-of-life subscale (19.9 versus 9.5 points) and on the SAQ physical limitation subscale (7.4 versus 2.1 points). SAQ angina stability or SAQ angina frequency subscales did not differ significantly between the groups. A significant reduction was seen in cardiac anxiety (Cardiac Anxiety Questionnaire [CAQ] summary score) in the CA-CBT group versus the usual care group (−12.5 versus −4.7 points). Across the CAQ fear, attention, and avoidance subscales, the reductions were consistent.
“It is important to understand that cardiac-related anxiety is common after a heart attack and that it can be treated. Digital therapy can be a way to reach more patients,” Johnsson said in a statement.
Two authors disclosed ties to the biopharmaceutical industry; one author disclosed ties to the publishing industry.
Cardiovascular disease continues to be the leading cause of death among Black Americans. Older Black adults are more likely to experience complications after a heart attack, including anxiety, depression, and reduced quality of life.
Research shows that psychological distress after a heart attack can affect recovery by making patients less likely to exercise, attend cardiac rehabilitation, adhere to pharmacologic interventions, or seek follow-up care.
For many older Black adults, fear after having a heart attack can be especially intense because of long-standing healthcare inequities, delayed diagnoses, financial stress, and previous negative healthcare experiences. Some patients may become hyperaware of normal bodily sensations, worrying that chest discomfort, fatigue, or shortness of breath means another cardiac event is happening.
This latest research suggests that digital cognitive behavioral therapy (CBT) could help patients manage those fears and regain confidence in daily activities. Researchers found that participants who finished the therapist-guided digital program reported improved quality of life and lower levels of cardiac anxiety compared to those receiving standard care alone.
Cardiac anxiety is more than just a temporary fear after a heart attack. It can lead to patients avoiding any physical activity, social engagement, and even routine medical care because they worry they might trigger another heart attack. Cardiac anxiety is described as a cycle of fear, hypervigilance, and avoidance behaviors that can interfere with long-term recovery.
For older Black adults, these challenges may overlap with other chronic conditions they’re already managing, including hypertension, diabetes, obesity, or kidney disease, all of which can increase cardiovascular risk. When anxiety goes untreated, it may become harder to follow heart-healthy lifestyle recommendations or participate in cardiac rehabilitation programs.
Black adults are historically underrepresented in both mental health treatment and cardiac rehabilitation participation. Barriers to care can include transportation, caregiving duties, being uninsured, a shortage of specialists, and stigma surrounding mental health care.
Digital CBT may help close these care gaps by enabling patients to access treatment from home. The study’s intervention was delivered over eight weeks and focused on helping patients gradually face their cardiac-related fears rather than avoid them.
The study’s findings raise important questions about future heart recovery programs for underserved populations.
Traditional cardiac rehabilitation programs can improve outcomes after a heart attack, but participation rates remain low nationwide. Older adults may struggle with transportation, mobility limitations, or scheduling changes. Digital behavioral health programs could offer a more flexible option, especially for patients living in medically underserved communities.
However, digital health tools must be designed with equity in mind. Some older Black adults can face barriers like limited broadband access, lower digital literacy, or a lack of familiarity with telehealth options. Expanding access to culturally responsive, user-friendly digital therapy could help ensure these tools benefit marginalized communities most affected by cardiovascular disease.
Abstract/Full Text – Main Clinical Results (subscription or payment may be required)
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