Taking mind matters to heart : E-health methods to assess and treat psychological distress associated with myocardial infarction and Takotsubo syndrome

This thesis comprises five studies investigating psychological distress in patients with myocardial infarction (MI) and Takotsubo syndrome (TS), with a focus on using e-health methods for data collection and delivery of psychological interventions. The aim of study 1 was to explore the long-term (12 month) effect of an internet-delivered intervention for MI patients experiencing self-reported symptoms of anxiety or depression compared to a control group without access to the treatment intervention. Using data from several Swedish national registers we also investigated whether the intervention had any effect on risk for adverse cardiovascular (CV) events, including recurrent MI and CV-related mortality. Effect of treatment was not significant between groups on lowering symptoms of anxiety or depression nor for risk of CV events or CV-related mortality. Low treatment adherence is discussed as a probable reason for these findings. Study 2 aimed to build from the lessons learned in study 1, as well as the existing literature and continuous input and collaboration with patient research partners (PRPs) to develop an internet intervention designed for patients experiencing high levels of anxiety or stress following MI with non-obstructed coronary arteries (MINOCA) or TS. We present the processes involved during the development and creation of this novel internet intervention. Following on from this, in Study 3 we tested the feasibility of this intervention using pre-specified progression criteria that was aimed to assess whether the intervention and study protocol were feasible in a randomised controlled trial (RCT). We screened patients for eligibility and offered participation in the study to those who met the pre-defined inclusion criteria. We collected both psychometric and qualitative data and assessed progression criteria that covered: recruitment, time and resources, proportion of participants completing the intervention and, participant experiences of the intervention. Study 4 used data from the Swedish national registers to estimate the association of health-related quality of life (HRQoL) with high vs low dose of β-blocker, prescribed after MI. The aim was to investigate, in advance of an ongoing register-based RCT, whether there is any association of β-blocker dose on patient reported HRQoL. Since there are many reasons for a patient to receive a high or low dose respectively, controlling for possible confounding was crucial. We used the European Quality of Life Five Dimensions questionnaire (EQ-5D) to assess HRQoL using data from over 35000 unique, first-time MI patients in Sweden. Study 5 presents the trial design, rationale and baseline data from the first 100 patients recruited into a registry-based RCT sub-study focussed on investigating several psychological-related outcomes in patients randomised to receive β-blocker treatment or no treatment. The feasibility, strengths and challenges of using digitalised in-hospital data collection techniques are also evaluated.