Psychosocial lifestyle interventions for secondary prevention of cardiovascular disease: Overcoming barriers in primary care

Modifiable risk factors for cardiovascular health are often associated with healthy diet, physical activity, and smoking cessation. Rarely is psychological stress mentioned or attributed to cardiovascular disease (CVD). However, the literature is beginning to recognize psychological stress as contributing to an increased risk of CVD (Aggarwal et al., 2021; Rippe, 2018; Walton et al., 2002). Acute stress may impact the autonomic nervous system, increasing heart rate and blood pressure, while chronic stress is associated with inflammation and the development of atherosclerosis (Aggarwal et al., 2021; Ware, 2008). Healthcare guidelines remark on the need to address modifiable risk factors in preventing and treating CVD (British Columbia [BC] Guidelines, 2023; Jain et al., 2022; Pearson et al., 2021). However, the guidelines provide poor directives regarding what intervention a practitioner should use, and how they should use it, to reduce or manage patient stress. Furthermore, implementation of lifestyle interventions can be challenging, and practitioners often face several barriers. Therefore, an integrative literature review was conducted to identify stress-reducing interventions that primary care nurse practitioners (NP) can implement when treating CVD. Nine articles were reviewed utilizing Cooper’s (1982) systematic approach for integrative literature reviews, a method first published in 1982 and frequently cited and used throughout the literature. Randomized controlled trials, cohort studies, and qualitative research were included in this analysis. Unfortunately, this review did not yield conclusive evidence that psychosocial interventions can achieve statistically significant results in the treatment of CVD compared to standard CVD treatment. Nevertheless, the practice recommendations are that psychosocial stress should be assessed and monitored for those with CVD, and that lifestyle interventions should continue to be promoted as adjuncts to traditional treatment regimes.