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Introduction: Since symptoms of anxiety have been recorded in 23% of patients upon admission to the outpatient cardiovascular rehabilitation program (OCVR) and depression symptoms have been recorded in 29% of patients1, the implementation of the program in the Cardiovascular Disease Prevention and Rehabilitation Institute in Zagreb (Institute)2 has been recently improved by occupational therapy3, consulting procedures by psychiatrists (examination and lecture)4 and music therapist (lecture and receptive music therapy). The aim of this paper is to present initial experience in applying the receptive music therapy in patients involved in the OCVR program. Patients and Methods: The implementation of the OCVR program in the Polyclinic has already been described.2 Hospital Anxiety and Depression Scale (HAD) has been used for assessment of anxiety and depression at the beginning and end of the OCVR program. All of the patients are involved in the psychodiagnostics of a clinical psychologist, and according to the indication of a psychologist and/or a cardiologist, a psychiatric examination has also been performed. The patients with borderline or pathological finding for HAD were involved in the program of receptive music therapy after applying additional diagnostic instruments5. Results: During the period from 30th June 2017 to 25th October 2018, receptive music therapy was applied in a total of 17 patients (10 men and 7 women), in whom the OCVR program was indicated for 14 of them after acute myocardial infarction, for one of them after coronary artery bypass grafting, and for two of them after unstable angina pectoris. Median time that elapsed from the acute cardiovascular event until the start of applying the receptive music therapy was 90 days. The evaluation by a psychologist was done in all 17, and an examination by a psychiatrist was done in 11 patients. Out of 190 music therapy services, there were altogether 170 music therapy sessions. The desired threshold of 8 or more music therapy sessions was achieved in 13 out of 17 patients. The self-assessment result by applying Hospital Anxiety and Depression Scale upon admission to the OCVR program was borderline or pathological in 15 and in 3 patients upon discharge. The mean values when doing the self-assessment on anxiety and depression particles by applying HAD were significantly higher at the beginning compared to those at the end of the OCVR program (anxiety 10 to 6, depression 7 to 4). The results on the Scale of the self-assessment of health condition at the end of music therapy are lower than those at the beginning (11.5 to 10). Conclusion: The treatment by receptive music therapy in patients involved in the OCVR program additionally con tributes to reducing anxiety and depression. The effect of this procedure should be considered as part of the benefit of the entire OCVR program and in a larger group of patients. [ABSTRACT FROM AUTHOR]

Introduction: Acute myocardial infarction (AMI) is one of the most severe cardiovascular incidents. The treatment, recovery and change in life style in a patient can result in fear, distress, insecurity, anxiety and depression. In order to improve the quality of recovery and reduce the risk of cardiovascular incidents, a cardiovascular rehabilitation program (CVR) is conducted, which, in addition to some other secondary prevention components, also includes a complete psychological care.1-3 The aim of this study was to determine the incidence of anxiety and depression in patients involved in the outpatient CVR program. Patients and Methods: The retrospective study was conducted in the Institute for Cardiovascular Prevention and Rehabilitation in Zagreb. The details about patients were collected for the period from 10th September 2015 to 31st December 2017. The patients with AMI basic diagnosis were divided into three groups: those treated by percutaneous coronary intervention (PCI), those treated by coronary artery bypass surgery (CABG) and those treated by optimal medical therapy (OMT). The structured Hospital Anxiety and Depression Scale (HADS) was used for screening of anxiety and depression at the beginning and end of the program of quarterly outpatient CVR.2,3 Results: 437 patients were involved in this trial of whom 367 were treated by applying PCI, 50 patients were treated by applying CABG and 20 patients were treated by applying OMT. The results (Table 1) show that out of the total number of patients at the beginning of the program, 18% of the them have borderline and clinically significant anxiety, and 22% of them have borderline and clinically significant depression. The values of anxiety at the discharge, compared to the anxiety at the beginning of the outpatient CVR program normalized in 10%, while the values of depression normalized in 11% of patients with AMI. Conclusion: Participation in the outpatient CVR program results in a decrease in self-assessed anxiety and depression in patients after AMI. The results of screening by using HADS show a better recovery in a group of patients treated by applying PCI. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular (CV) diseases and psychiatric disorders are common problems, not only in the general population, but also in patients enrolled in the CV rehabilitation program. The interaction of anxiety and/or depression on CV disease is not only a barrier to conducting the program, but also significantly affects the outcomes of the program.1'2 Therefore, timely diagnosis of cardiac and psychiatric symptoms in patients undergoing CV rehabilitation allows adequate treatment which results in the improvement of the quality of life and outcome of the CV disease. This paper aims to show that early screening by using structured HAD scale (Hospital Anxiety and Depression Scale)3 that evaluates anxiety and depression can help us determine the recovery after the outpatient CV rehabilitation program is completed. Patients and Methods: The Institute for Cardiovascular Prevention and Rehabilitation in Zagreb has conducted the retrospective study. All patients undergoing the outpatient CV rehabilitation program were rehabilitated during the period from 10th September 2015 that completed the program prior to 29th September 2016. Demographic data was analyzed. The leading indicators for the enrollment in the program were acute coronary syndrome (group 1), heart surgery treatment (group 2) or cardiac implantable electronic devices (group 3). By using the HAD scale, the patients were tested at the beginning and end of the program. The results were presented by groups by using the descriptive statistics methods. Results: The analysis was conducted in a total of 215 patients who completed the program. Most of them were enrolled in group 1 (74.9%), followed by the group 2 (20.0%) and group 3 (5.1%). Demographic characteristics are shown in Table 1. The test results by using the HAD scale at the beginning and end of the CV rehabilitation by groups of patients are shown in Table 2. Conclusion: Most patients enrolled in the CV rehabilitation has a history of some form of acute coronary syndrome (ACS). In addition 3 out of 4 patients enrolled in the program are men. On completion of the rehabilitation program, a large number of patients have normal values of anxiety and de [ABSTRACT FROM AUTHOR]