Please select the eligibility criteria that correspond to the clinical trial below.
Title: Improving the Effectiveness of Psychological Interventions for Depression and Anxiety in the Cardiac Rehabilitation Pathway: A Single-blind Randomised Controlled Trial
Brief Summary: Cardiac rehabilitation (CR) services aim to improve heart disease patients' health and quality of life, and reduce the risk of further cardiac events. Depression and anxiety (distress) are common among CR patients: 37% of patents have significant anxiety and/or depressive symptoms. Distressed patients are at greater risk of death, further cardiac events and poorer quality of life than those without distress and they use more healthcare. Available drug and psychological treatments have only small effects on distress and quality of life, and no effects on physical health. Therefore, it is essential that more effective treatments for depression and anxiety are integrated into CR services. Extensive evidence shows that a particular style of thinking dominated by rumination (dwelling on the past) and worry maintains emotional distress. A psychological intervention (metacognitive therapy) that reduces this style of thinking alleviates depression and anxiety in mental health settings. The investigators aim to conduct a pilot trial of the group intervention and in work stream 2 the investigators will undertake a full-scale trial to evaluate whether adding the group intervention to standard CR is more effective at alleviating anxiety and depression than standard CR alone.


Options:
A: Inclusion Criteria:

Prospective Cohort

* Written informed consent
* Age 18 years and older
* New diagnosis of non-valvular atrial fibrillation (diagnosed within the last 6 weeks) with at least one additional risk factor for stroke and regardless of therapy.

Retrospective validation cohort

* Written informed consent
* Age 18 years and older
* Diagnosis of non-valvular AF (diagnosed 6-24 months prior to enrolment) with at least one additional risk factor for stroke and regardless of therapy.

Exclusion criteria:

* No further follow-up envisaged or possible within enrolling hospital or with associated family practitioner.
* Patients with transient AF secondary to a reversible cause.
* Patients recruited in controlled clinical trials.
B: Inclusion Criteria:

* Age \>21 years,
* ICD Implantation,
* \> 3 months following ICD implantation,
* willingness to give informed consent

Exclusion Criteria:

* Episodes within prior 3 months of: acute coronary syndrome, myocardial infraction, Coronary Artery By-pass Graft surgery, percutaneous coronary intervention, hospital admission any cause,
* severe mental illness,
* life expectancy \< 1 year,
* hyperkalemia,
* hypokalemia,
* hypomagnesemia,
* hypermagnesemia,
* unwillingness to give informed consent
C: Inclusion Criteria:

* Patients with coronary artery disease
* German speaking men and women
* Recent coronary angiogram (\<= 3 months old)
* Depression score (HADS-D) \>= 8
* Written informed consent

Exclusion Criteria:

* Severe heart failure
* Other acutely life- threatening conditions
* Severe chronic inflammatory disease
* Current suicidal tendency
* Severe depressive episode
* Other severe mental illness.
D: Inclusion Criteria:

* Heart disease patients referred to CR with: Acute coronary syndrome
* Following revascularisation; stable heart failure
* Stable angina, implanted cardioverter defibrillators
* Heart valve repair/replacement
* Heart transplantation and ventricular assist devices
* Adult congenital heart disease
* Must have a score of 8 or more on either the depression or anxiety subscale of the HADS
* Competent level of English language skills

Exclusion Criteria:

* Cognitive impairment which precludes informed consent/ability to participate
* Acute suicidality
* Active psychotic disorders
* Current drug/alcohol abuse
* Concurrent psychological intervention for emotional distress
* Antidepressant or anxiolytic medication initiated in previous 8 weeks
* Life expectancy of less than 12 months

Answer: D