Research
Talking therapy boosts recovery from 'broken heart' syndrome
Cognitive behavioural therapy can improve fitness and heart muscle recovery in people with Takotsubo syndrome, according to the results of a trial funded by us and presented at the European Society of Cardiology Congress in Madrid.
The first ever randomised controlled trial of long-term treatments for Takotsubo syndrome – often referred to as broken heart syndrome – found that 12 weeks of tailored cognitive behavioural therapy, or a heart recovery exercise programme, resulted in signs of a physical improvement in patients’ condition, when compared to usual care.
Takotsubo syndrome is a condition where the heart muscle changes shape and suddenly weakens. It is usually triggered by severe emotional or physical stress, such as during a bereavement, and can cause symptoms similar to a heart attack. Patients with takotsubo syndrome have twice the risk of death compared to the general population.
Debilitating symptoms
Some patients are left with heart failure, resulting in debilitating symptoms like fatigue, as well as contributing to a shorter life expectancy. There are currently no treatments recommended specifically for patients with Takotsubo syndrome.
In the University of Aberdeen study, the average distance which patients that had cognitive behavioural therapy could walk in six minutes increased from 402 metres to 458 metres. People who took part in the exercise programme were able to walk an average of 528 metres in six minutes by the end of the study, compared to 457 metres at the start.
There was also an increase in patient’s VO2 max, their body’s maximum oxygen consumption at peak exercise, of 15 per cent in the CBT group and 18 per cent in the exercise group.
Increases in walking distance and VO2 max are signs of improvement in fitness. In contrast, there was little change in both measures during the trial in the patient group that only received standard care.
‘The brain-heart axis’
Dr David Gamble, Clinical Lecturer in Cardiology in Professor Dana Dawson’s research group at the University of Aberdeen, presented the research. He said: “In Takotsubo syndrome, there are serious effects on the heart, which may not return to normal. We know that patients can be affected for the rest of their lives and that their long-term heart health is similar to people who have survived a heart attack.
“These results further highlight the importance of ‘the brain-heart axis’. It shows that cognitive behavioural therapy or exercise could help patients along the road to recovery. Both are very cost-effective interventions, and we hope that further studies could lead to them being used to help this underserved group across the country.”
Takotsubo syndrome affects up to 5,000 people in the UK every year and, while heart function often returns to normal within weeks, the condition has been shown to have a significant impact on patients quality of life and life expectancy.
The study involved 76 patients with Takotsubo syndrome – 91 per cent were women and the average age was 66. Patients were randomly assigned to receive cognitive behavioural therapy, the exercise programme, or standard care. All participants received all other care and treatment recommended by their cardiologist.
The cognitive behavioural therapy group had 12 one-to-one weekly sessions, specifically adapted to their condition by the researchers, as well as daily support if needed.
The exercise group went through a 12-week exercise course which included cycling machines, treadmills, aerobics and swimming, gradually increasing in number of sessions and intensity each week.
Sophisticated imaging
Researchers also used a sophisticated imaging technique called 31P-Magnetic Resonance Spectroscopy, which allowed them to study how patient’s hearts were producing, storing and using energy – the heart’s metabolism. Researchers in Aberdeen have previously shown that patients with Takotsubo syndrome have a significant impairment to how their hearts handle energy and that this persists long term.
The imaging showed that, after 12 weeks of cognitive behavioural therapy or exercise, there was an increase in the amount of fuel available to patients’ hearts to allow them to pump, which was not seen in people who had usual care.
These results are a sign that the programmes tested could produce medium to longer term benefits, such as reducing symptoms and risk of dying, for patients with Takotsubo syndrome in the future.
Researchers will now test whether the treatments improve patients’ health, and reduce their risk of dying, over a longer period. They hope that either programme could be recommended on the NHS.
Devastating condition
Dr Sonya Babu-Narayan, our Clinical Director and consultant cardiologist, said: “Takotsubo syndrome can be a devastating condition that can affect you at a really vulnerable time if triggered by a major life event.
“People may not be as surprised that an exercise programme helped heart patients, but it is intriguing that this study also showed that cognitive behavioural therapy improved heart function and patients’ fitness. More research is needed to find out whether these approaches improve survival or symptoms over the long term.”