Integrated psychological care in inherited cardiac conditions: a multidisciplinary model from a national referral center
V Varela, M Vlachopoulou, A Miliou, C Papageorgiou, A Antonopoulos, G Lazaros, K P Tsioufis, C C Papageorgiou, C VlachopoulosAbstract
Background
Inherited cardiac conditions (ICCs), including hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy, are associated with elevated risk of sudden cardiac death and increasing use of genetic testing and implantable cardioverter defibrillators (ICDs). Alongside medical risk, patients frequently experience significant psychological distress, which may negatively affect adherence, lifestyle modification, follow-up engagement, and quality of life. Despite ESC recommendations emphasizing mental health integration, structured psychological pathways remain underdeveloped in cardiogenetic care.
Purpose
To present an embedded psychological care model implemented within a national tertiary ICC referral center and to report psychological profile data from this patient population.
Methods
All patients attending the ICC service receive standardized psychoeducation and psychological screening (GAD-7, PHQ-9, PCL-5), followed by stepped-care triage. Brief targeted interventions (2–6 sessions), based on cognitive-behavioral and acceptance-based approaches, are delivered within the cardiology setting when indicated. The pathway includes interdisciplinary case discussion and cognitive screening where appropriate.
Results
Aggregated data from our referral cohort demonstrate clinically significant levels of anxiety, trauma-related symptoms, depressive distress, and interoceptive dysregulation in a substantial subset of ICC patients. Distress was commonly associated with catastrophic misinterpretation of cardiac sensations, trauma following ICD shocks, avoidance of exertion or follow-up, and concerns related to genetic transmission. The integrated model targets these mechanisms through structured cognitive-behavioral strategies (e.g., cognitive restructuring, graded return to activity, trauma-focused techniques) alongside acceptance-based processes that promote psychological flexibility and values-guided engagement despite ongoing medical uncertainty. Clinical vignettes illustrate applicability across age groups and disease stages.
Conclusions
Data from a national ICC referral center underscore the substantial psychological burden accompanying inherited cardiac disease. Embedding structured psychological care within multidisciplinary cardiogenetic services is feasible, scalable, and aligned with the 2025 ESC Mental Health Consensus. Integrating psychocardiology into routine ICC management may improve adherence, patient engagement, and overall outcomes.