Outpatient Cardiovascular Psychiatry: A High-Yield Framework for Building a C-L Psychiatry Clinic Using Examples from the Field

Cardiovascular Psychiatry is increasingly recognized as a sub-specialty of consultation liaison (CL) psychiatry with the potential for widespread impact for patients across the spectrum of cardiovascular disease. Common cardiovascular conditions resulting in inpatient CL consultation include congenital heart disease in the child and adult, cardiac transplant and mechanical circulatory support, aborted sudden cardiac death, ventricular tachycardia and ICD storm, endocarditis in the setting of opioid use disorder, and post-surgical complications. The earliest cardiovascular psychiatry literature from the 1980s-90s describes the complex role of the CL psychiatrist (Hackett and Cassem, 1982; Fricchione et al., 1994). Expertise is required in a variety of areas, including: cardiac physiology and the relationship with the autonomic nervous system; complex medication management in patients taking high-risk medications and/or receiving intensive medical/surgical care; mechanics and psychological consequences of implanted devices and heart transplantation; principles of trauma-informed care; impact of early-life congenital cardiac disease on development and families; comfort with psychotherapy focused on coping, grief, and loss; and patient advocacy; among many others. While most inpatient CL services are able to support the unique psychiatric needs of such patients while in the general medical hospital, there is both a paucity of sub-specialty outpatient cardiovascular psychiatry clinics to serve the long-term mental health needs of these patients, and a great opportunity for CL psychiatrists to lead development of outpatient cardiovascular psychiatry services.

In this high-yield workshop for psychiatrists of all stages of training and practice, sponsored by the ACLP Cardiovascular Psychiatry Special Interest Group, we will use real-life examples of outpatient cardiovascular psychiatry clinics at three different academic medical centers to guide the learner through a framework for establishing an outpatient CL clinic. While our examples will focus on cardiovascular psychiatry, the framework can be applied to any CL sub-specialty.

In the first part of the workshop (35 minutes), Drs. Funk, Suarez and Styra will describe unique approaches to building outpatient cardiovascular psychiatry services at three different medical centers in the U.S. and Canada. They will discuss models of care, types of services, collaboration with cardiology colleagues, referral systems and triage, financial and space considerations, and processes for measuring outcomes and clinic success.

In the second part of the workshop (20 minutes), the speakers will discuss important specialty-specific aspects of outpatient clinical care for patients with cardiovascular illness. Dr. Rajagopalan will discuss unique considerations when working with children with congenital heart disease, including common psychiatric comorbidities and the approach to working with parents and other caregivers. Dr. Vartak will discuss the role of moderated support groups for a cohort of aortic dissection patients with guidance on how to expand such a model to other specialty patient populations. Speakers will discuss the trainee experience of working in a cardiovascular psychiatry specialty clinic including pearls for maximizing trainee learning.

In the third experiential part of the workshop (20 minutes), participants will craft a working draft of an outpatient clinic development plan using the presented framework. The final 15 minutes of the workshop will be open Q&A with the panel of speakers.