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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]

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In the last few decades, the awareness of the impact of the psychological functioning on the cardiovascular (CV) system has been rising. Science has first recognized the negative effects of stress followed by other psychological factors. Recently, attention has been focused on the negative impact of depression and anxiety on the development of CV disease and the prognosis of patients after CV incident. Accordingly, many countries and global organizations have recognized the need for a comprehensive CV rehabilitation. Modern rehabilitation of CV patients should therefore involve well-educated interdisciplinary team that will, among other things, provide patients high quality psychosocial care.1 Various scientific sources suggest that 11-25% of patients with coronary heart disease develop clinically significant depression, and about 30% have a mild depressive disorder. 10-50% CV patients develop clinically significant anxiety. The problem concerning the psychological risk factors is even greater with respect to the results of research on sub-diagnostics and failure to treat mental diseases and disorders in CV patients. Institute for Cardiovascular Prevention and Rehabilitation has in the last two years in its outpatient cardiac rehabilitation program, along with standard psychological care2, taken steps for early detection of psychological risk factors and the overall management of patients with severe mental disorders. Thus, all patients are at the time of enrollment subject to screening for anxiety and depression by using Hospital Anxiety and Depression scale3. In addition to a psychologist working for the Institute, the team is also joined by permanent associate - a psychiatrist from the Psychiatric Hospital 'Sv. Ivan". For patients who are assumed to need additional workup and permanent treatment, care is provided in the Referral Centre of the Ministry of Health for Disorders Caused by Stress, in the University Hospital Dubrava. In this way, the care of psychological risk factors has been completed and the element for effective CV rehabilitation has been added. [ABSTRACT FROM AUTHOR]

Within behavioral cardiology, the existence of psychological risks for cardiovascular diseases (CVD) is known and scientifically proven. In the past 10 years research has focused on identifying the possible protective effects on cardiovascular health of positive psychological states and health characteristics in general. So far the following positive effects have been investigated: optimism, gratitude, spirituality, humour, general psychological well-being, vitality, sense of purpose, sense of self-worth, positive curiosity, joy, forgiveness, resilience and life satisfaction. It is anticipated that future research will go in the direction of: 1. determining specific protective psychological factors for CVD; 2. establishing mechanisms to assess the impact of these factors on the health of the heart and of the blood vessels; 3. developing appropriate interventions for the promotion and strengthening of these protective factors. In practice, such a focus on psychological states and characteristics of people will result in the need for new psychological measurement instruments (questionnaires, tests, etc.) and the need for new skills and techniques for the development of psychological resources to improve the positive potential of people. Ultimately it will be necessary to invent new strategies of primary and secondary prevention of CVD. [ABSTRACT FROM AUTHOR]

The aim of this study was to find out and compare characteristics of cardiac patients who, after hospital treatment, participated in cardiac rehabilitation programmes at the Polyclinic for Cardiovascular Prevention and Rehabilitation in Zagreb during 1999 and 2009. The results show an increase in mean patients' age (men: 55.5 to 61.53; p = 0.000 and women: 58.95 to 62.66; p = 0.01), an increase of the proportion of those +/- 65 years by 23% in both genders (men: 17% to 40%; women: 27% to 50%), an increase in the proportion of women (21.16% to 28.22%), a marked increase in the proportion of post - PCI patients with stenting (men: 15.58% to 61.92%; women: 9.68% to 62.20%), reduction of patients with BMI < 25.00 kg/m2 (men: 47.19% to 13.93%; women: 54.84% to 24.41%) and a constantly high proportion of patients with hypercholesterolemia (above 85%). It is obvious that systematic action is required to improve awareness of risk factors and desirable health behaviour.