Program aims to raise awareness of integrated cardiac care

Mental health issues often have physical symptoms and that could not be clearer than when working with cardiac patients.

It is a correlation that surprises no one. Distress can affect heart rate and blood pressure, which affects how the heart works. Faced with a life-changing diagnosis or the prospect of a life-threatening medical procedure, people often experience increased fear and anxiety, which can, in turn, affect medical outcomes.

Yet, the relationship and how to best provide treatment is only now coming into focus.

At Yale’s Vascular Medicine Outcomes (VAMOS) lab, Kim Smolderen, Ph.D., and her team have been working collaboratively with researchers around the globe to better define the risk factors of poor mental health in vascular disease.

Over the past six years of the lab’s existence, they have helped compile an evidence base for understanding how mental health factors play a part in cardiac events and can impede recovery and best practices in treatment.

“We know that psychosocial factors play a pivotal role in whether or not patients get optimal benefit from treatments and whether or not their outcomes following interventions potentially are more complicated,” said Smolderen. “So, now we have the numbers for that and now we also have evidence that there are treatments that improve depression and anxiety in medical patients. Bringing those treatments to the patients in those clinical pathways was really the next step.”

In 2025, Smolderen took that next step, putting the research to work, with the creation of the Yale Medicine Heart and Vascular Psychology and Wellbeing Clinic, an integrated behavioral and medical health pilot program at Yale New Haven Health.

Mental health clinicians provide evaluation and short-term psychotherapy for patients whose cardiac doctors have identified them as possibly having mental health issues that could impact care.

“I have to say that the referrals I am getting are really on target,” said Smolderen. “For them, it was not a matter of identifying the cases, because they have always seen them but they didn’t know where to send them.”

Clinicians work with patients on reducing anxiety or depression, addressing how past trauma can be triggered by a cardiac event, teaching self-coping tools, and discussing how lifestyle changes will impact their quality of life going forward.

“The result I am hoping to see is the integration of this new reality in a way that doesn’t dominate their day-to-day thinking and that they get to experience the enjoyment of life again,” she said. It may look a little different, but it should still resonate with who they are as person.”

With this pilot program, Smolderen and her team will continue assessing patient outcomes to further tweak care recommendations. She hopes to offer student training programs and increase awareness of the need for integrated care for cardiac patients.

“Our hope is that we can build the foundation and that we can grow it,” she said.