Digital Cognitive Behavioral Therapy for Cardiac Anxiety After Myocardial Infarction: Effects on Disease-Specific Health Status-Detailed Methods and Protocol.

BACKGROUND

Cardiac anxiety, characterized by cardiac-related fear and avoidance, is common after myocardial infarction (MI) and is associated with reduced quality of life and adverse prognosis. Despite its clinical relevance, cardiac anxiety remains underaddressed in routine post-MI care.

OBJECTIVES

The objective of the study was to evaluate the efficacy of a therapist-guided, digitally delivered exposure-based cognitive behavioral therapy intervention for cardiac anxiety (CA-CBT) in patients after MI.

METHODS

In this randomized clinical trial, patients with a history of type 1 MI (≥6 months prior) and clinically significant cardiac anxiety were randomly assigned to 8 weeks of digital CA-CBT or usual care. The primary outcome was disease-specific health status assessed at 3-month follow-up using the Seattle Angina Questionnaire; cardiac anxiety was also assessed.

RESULTS

Compared with usual care, CA-CBT was associated with greater improvements in disease-specific health status, particularly quality of life and physical limitation, as well as greater reductions in cardiac anxiety. Treatment effects were sustained at 12 months.

CONCLUSIONS

A therapist-guided, digitally delivered CBT intervention targeting cardiac anxiety improved disease-specific health status and reduced cardiac anxiety after MI, with durable effects. These findings support the clinical relevance of integrating psychological interventions into multidisciplinary secondary prevention after MI. (Online Cognitive Behavioral Therapy Targeting Cardiac Anxiety [MI-CBT]; NCT05580718).