Dr Rosemary Higgins 2

Dr Rosemary Higgins

Clinical Consultant

Honorary Associate Professor, Faculty of Health, Deakin University

Honorary Senior Fellow, Department of Physiotheraphy, University of Melbourne

I’m a cardiac health psychologist, specialising in helping heart patients live better. My research focuses on how our moods, our thoughts, and our social situations affect physical health and quality of life.

Heart attacks and bypass surgery often are life changing. Some patients talk about having been given a ‘second chance at life’ and others say “I’ve been given a wake-up call. It is time for me to rethink my priorities and make some big changes.” Others become deeply depressed or extremely anxious. My research is focused on how best to help this great range of patients in their new lives.

As everyone knows, cardiac patients are told to make many changes; often an overwhelming number of substantial changes. Patients are commonly told to change their diet, stop eating some foods, eat less of others, and sometimes advised to eat foods that they don’t like. Many will be advised to exercise more, even people who have never been to a gym in their life. Others will be told to stop smoking and drink much less alcohol. On top of all this, all patients are told that they will need to take medicines daily for the rest of their life. They have entered the world of chronic disease and need to learn to manage their illness and its symptoms.

On top of all this, patients also need to deal with powerful feelings -- about having heart disease and its impact on their lives. Some patients get depressed, others feel extreme anxiety like they have a ‘ticking time bomb’ in their chest, while still others rethink their lives and report living better than ever [learn more: Psychological adjustment after an acute cardiac event and Emotional adjustment issues faced by cardiac patients]. 

How can health professionals best help such patients, with their great range of behavioural challenges and emotional reactions? Clearly, there is no one-size-fits-all solution. My research focuses on getting more people to cardiac rehabilitation programs and on increasing the quality of those programs.

We have shown that patients have a range of reasons for not attending cardiac rehabilitation. I found that improving hospital referral systems leads to around double the number of patients attending rehabilitation [learn more: Overcoming the barriers to cardiac rehabilitation attendance]. I also found that while 50% of patients want group cardiac rehabilitation as their first preference, others want to work one-on-one with a health professional, still others prefer a home-based rehabilitation program [learn more: Health education of patients in rehabilitation]. So, I am developing internet (Help Yourself Online) and telephone (Teleheart) versions of our cardiac rehabilitation programs. These programs will soon be available to cardiac patients Australia-wide. 

Our research has found that many patients do not understand what led to their heart disease.  We found that only 5% of those with high blood pressure believed it was a cause and only 15% of overweight patients named their weight [learn more: Perceived causes of heart disease among patients]. Even more bothersome, these important misunderstandings remained in many even when they attended cardiac rehabilitation classes. Further, and this is not surprising, while many patients initial change their diet and exercise habits, often they fail to keep these changes. This is true even of those who reliably attend their rehabilitation classes [learn more: Changes in fat intake for cardiac patients].

Clearly patients need additional support. But what type of support really does help people understand their condition and produce the needed long-term changes? Research was needed and some of our HRC results were illuminating. What type of support can get them to keep them eating a diet low in saturated fats? Or to develop a life where walking, swimming or cycling is a natural part of the day? Our Beating Heart Problems research developed a self-management program that helps patients make long-lasting behaviour change, changes that people actually do for years. 

At the risk of bragging, I am so pleased with our results - patients who attended the program cut their risk of a further heart attack in half! 

Further, Beating Heart Problems attendees were far less likely to be depressed - three months later, non-attendees were four times more likely to be depressed than attendees. This matters, not only because depression is bad in itself, but because it prevents people from making changes that they would otherwise make. 

Having great results in the research literature is only our first step; the HRC also develops programs that help health professionals apply those results in their clinical practice. I led the development of the HRC’s Supporting Chronic Disease Self Management training, which has been taken by more than 2000 health Australian health professionals. Further research has shown that the training works [learn more: Outcomes of chronic heart failure training program and Role of stress management training in cardiac rehabilitation] - these health professionals have changed the way that they support patients with the challenge of behaviour change using evidence-based strategies to support long-term change.

Our research can help identify those hospitalized patients who will need the most assistance after leaving hospital. Clinicians can then organize the needed after-discharge support. Patients who live alone are 3 times more likely to have to go back into hospital after cardiac surgery, and depressed patients were 2 times more likely to be readmitted [learn more: Impact of living alone on likelihood of readmission]. Importantly, patients whose depression got worse after leaving hospital were nearly five times more likely to have died within 12 years than patients whose depression improved [learn more: Mortality trajectory after an acute cardiac event]. Although many hospitals regularly measure depression while in hospital, our results show this is not enough – depression should also be reassessed a couple of months after discharge to ensure identification and treatment of patients at risk. Helping cardiac rehabilitation experts identify depression risk is a major part of our work [learn more: The Cardiac Blues Project]. 

In addition to training health professionals, our patient resources help patients develop their own strategies to address their depression [learn more: Cardiac Blues 'On Track' resources for patients and health professionals].

Our research has shown that health professionals also need training to understand the importance of psychological, social and behavioural factors in managing heart disease. They need to learn how to manage the whole person’s health, not just their diseased heart! 

Over my 17 years at the Australian Centre for Heart Health (including when it was known as the Heart Research Centre), I have developed eight new training programs and trained thousands of health professionals. I have even developed online training to ensure distance is not a barrier to training. In another innovation, we are building the HRC network (hearthealthconnect.org.au) to enhance learning opportunities for cardiac rehabilitation specialists. We are constantly revising our training to reflects the latest research and better help both health professionals and their patients. 

I am lucky to have such a fascinating, intellectually satisfying job. The research and the programs it informs already are helping many people.