From Percutaneous Coronary Intervention (PCI) to Heart Rate Variability (HRV) Biofeedback: The Bridge Between High-Tech Medicine and High-Tech Psychology—How Can We Proceed in Clinical Practice?

Acute coronary syndromes (ACS), including unstable angina (UA) and myocardial infarction (MI), are clinical symptoms of heart disease, called ischemic heart disease (IHD), and are important causes of death worldwide and in Poland. Medical associations including the European Cardiac Society (ECS) and the American Heart Association (AHA) recognize psychological factors, including depression, anxiety, and stress, as important factors that influence progression of IHD among patients after ACS. Data are accumulating, showing that psychophysiological interventions and relaxation exercises improve clinical outcome in cardiac patients. In the medical literature, however, a number of clinical randomized, controlled studies document the effectiveness of practical medical recommendations (evidence-based medicine, EBM), but very little available data and almost no evidence-based guidelines support physician use of practical implementation of psychophysiological practice or relaxation. The present article describes a study in a Polish hospital cardiology unit, utilizing a psychophysiological stress profile (PSP) to assess patients after myocardial infarction, to assess which patients can utilize paced diaphragmatic breathing as home practice without extended biofeedback training, and which require more extensive biofeedback training. The article discusses safety issues in the use of a PSP in cardiac populations, and possible practical consequences of using a psychophysiological stress profile in clinical cardiac practice.