Paving the Way for Better Cardiovascular Behavioral Medicine: The Need for Implementation Science

Allison E. Gaffey, PhD^✉ and Alyssa M. Vela, PhD^✉; Cardiovascular Disease SIG

The field of Implementation Science (IS) has great promise to improve cardiovascular behavioral medicine services. IS promotes the scientific study and application of evidence-based clinical practices in routine care, to improve quality and effectiveness of healthcare services (Eccles & Mittman, 2006; Galaviz & Barnes, 2021; Presseau et al., 2021). Interventions that are based on IS can occur at the patient, health care provider, organization, and policy levels. Although the patient is often thought of first, intervening across all levels is critical to effectively translate theories of affect, behavior, and cognition in health (Michie, West, & Spring, 2013; Presseau et al., 2021).

The specialty area of “cardiovascular behavioral medicine” has been developed and implemented in a variety of clinical settings to more effectively address the behavioral and lifestyle factors that contribute to cardiovascular disease. The multidisciplinary, patient-centered approach of IS can aid the scientifically informed integration of behavioral medicine providers into cardiovascular specialty care and rehabilitation and patient engagement (Burg, 2018). This is especially true given the value of targeting lifestyle factors for cardiovascular risk reduction (Virani et al., 2021). However, integrated multidisciplinary cardiovascular care remains a rare exception rather than the norm. In response to this need, the Cardiovascular Disease (CVD) Special Interest Group urges the expansion of research and training in IS to better integrate cardiovascular behavioral medicine services, and help broaden this standard of care.

While providers can anecdotally share experiences about the development and integration of behavioral service lines in cardiovascular medicine clinics, the field of cardiovascular behavioral medicine requires more organized, systematic investigation of the barriers to, and facilitators of, successful integration. As observed by Presseau and colleagues (2021), IS has benefited significantly from behavioral medicine research, but behavioral medicine, including the health psychology subspecialty, needs to reciprocally draw from IS tools and methods. Doing so can improve the scientific dialogue between cardiovascular behavioral research and practice, and galvanize funding, institutional resources, and training for IS. At the patient level, it should first be determined if evidence for a behavioral intervention is sufficient to systematically implement in an effort to mitigate cardiovascular risk (Presseau et al., 2021). If evidence is insufficient, it is critical to identify remaining evidence-practice gaps and/or barriers to implementation. On provider and systematic levels, there is enormous potential for investigation. For example, thinking about healthcare systems as implementation laboratories, with research occurring within specific settings, is one underutilized opportunity (Grimshaw et al., 2019; Presseau et al., 2021).

Given the high burden of cardiovascular risk and disease among minority racial and ethnic groups, and based on socioeconomic status (Virani et al., 2021), advancing health equity must be a priority when applying IS approaches within cardiovascular behavioral medicine (Brownson, Kumanyika, Kreuter, & Haire-Joshu, 2021; Sterling, Echeverría, Commodore-Mensah, Breland, & Nunez-Smith, 2019). IS provides an excellent vehicle to integrate equity into models, use group-specific metrics, tailor implementation strategies, interact with external organizations, and prioritize equity in dissemination (Brownson et al., 2021). Thus, IS can account for and assess the influence of social context on cardiovascular health and disease risk. Altogether, there are immense opportunities to improve cardiovascular care, and mitigate significant cardiovascular risk, through IS. Behavioral medicine researchers and clinicians are well-positioned to take on this vital work to advance cardiovascular care.

Thank you to the members of the CVD SIG who contributed their insight and experiences to allow for the development of this article.

Please see recordings of the CVD SIG’s August, 2021 panel discussions on behavioral health integration in cardiac rehabilitation and other CVD clinics.

 

References

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Burg, M. M. (2018). Psychological treatment of cardiac patients: American Psychological Association.

Eccles, M. P., & Mittman, B. S. (2006). Welcome to implementation science. In: Springer.

Galaviz, K. I., & Barnes, G. D. (2021). Implementation Science Opportunities in Cardiovascular Medicine. In: Am Heart Assoc.

Grimshaw, J., Ivers, N., Linklater, S., Foy, R., Francis, J. J., Gude, W. T., & Hysong, S. J. (2019). Reinvigorating stagnant science: implementation laboratories and a meta-laboratory to efficiently advance the science of audit and feedback. BMJ quality & safety, 28(5), 416-423.

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Presseau, J., Byrne-Davis, L. M., Hotham, S., Lorencatto, F., Potthoff, S., Atkinson, L., . . . French, D. (2021). Enhancing the translation of health behaviour change research into practice: a selective conceptual review of the synergy between implementation science and health psychology. Health psychology review, 1-28.

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Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., . . . Delling, F. N. (2021). Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation, 143(8), e254-e743.