Psychological Interventions for Coronary Heart Disease: Cochrane Systematic Review and Meta-analysis
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Depression and anxiety are common in cardiac patients, and psychological interventions may also be used as part of general cardiac rehabilitation programs.
This study aims to estimate effects of psychological interventions on mortality and psychological symptoms in this group, updating an existing Cochrane Review.
Systematic review and meta-regression analyses of randomized trials evaluating a psychological treatment delivered by trained staff to patients with a diagnosed cardiac disease, with a follow-up of at least 6 months, were used.
There was no strong evidence that psychological intervention reduced total deaths, risk of revascularization, or non-fatal infarction. Psychological intervention did result in small/moderate improvements in depression and anxiety, and there was a small effect for cardiac mortality.
Psychological treatments appear effective in treating patients with psychological symptoms of coronary heart disease. Uncertainty remains regarding the subgroups of patients who would benefit most from treatment and the characteristics of successful interventions.
KeywordsCoronary heart disease Psychological interventions Cardiac rehabilitation Secondary prevention Systematic review Meta-analysis
We would like to acknowledge all the authors who provided additional information on request and Cornelia Junghans for Russian and German translations. Ben Whalley was supported by an ESRC fellowship (PTA-026-27-2113). We also wish to acknowledge the authors of the original Cochrane review as follows: Karen Rees, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK; Philippa Davies, Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK; Paul Bennett, Department of Psychology, University of Swansea, Swansea, UK; Shah Ebrahim, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Zulian Liu, Peninsula Medical School, University of Exeter, Exeter, UK; Robert West, Wales Heart Research Institute, Cardiff University, Cardiff, UK; and Tiffany Moxham, Wimberly Library, Florida Atlantic University, Boca Raton, Florida, USA. The study was funded by a UK National Institute for Health Research Cochrane Programme Grant (CPG510).
Conflict of Interest
- 8.Cesari M, Penninx BBWJH, Newman AAB, et al. Inflammatory markers and onset of cardiovascular events. Circulation. 2003;108(19):2317–22. Available at: http://circ.ahajournals.org/content/108/19/2317.short. Accessed February 29, 2012.PubMedCrossRefGoogle Scholar
- 9.Hansson GK. Immune mechanisms in atherosclerosis. Arterioscler Thromb Vasc Biol. 2001;21(12):1876–90. Available at: http://atvb.ahajournals.org/cgi/content/abstract/21/12/1876. Accessed March 26, 2012.PubMedCrossRefGoogle Scholar
- 17.Burnett-Zeigler I, Zivin K, Ilgen M, et al. Depression treatment in older adult veterans. Am J Geriatr Psychiatr. 2010.Google Scholar
- 22.Erdman RAM, Duivenvoorden HJ. Psychologic evaluation of a cardiac rehabilitation program: a randomized clinical trial in patients with myocardial infarction. J Cardiopulm Rehabil Prev. 1983;3(10):696–704.Google Scholar
- 25.ENRICHD. Enhancing Recovery in Coronary Heart Disease (ENRICHD) study intervention: rationale and design. Psychosom Med. 2001;63(5):747–55.Google Scholar
- 29.Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed). 2011;343:d5928. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3196245&tool=pmcentrez&rendertype=abstract. Accessed March 19, 2012.CrossRefGoogle Scholar
- 30.Cochrane. Preferred method for handling continuous variables. 2003. Available at: http://heart.cochrane.org/resources-review-authors.
- 32.Hersen M, Hilsenroth MJ, Segal DL. Comprehensive handbook of psychological assessment. Hoboken: Wiley; 2004.Google Scholar
- 43.Rahe RH, Ward HW, Hayes V. Brief group therapy in myocardial infarction rehabilitation: three- to four-year follow-up of a controlled trial. Psychosom Med. 1979;51(3):229–42.Google Scholar
- 53.Peng J, Jiang LJ. Psychotherapy on negative emotions for the incidence of ischemia-related events in patients with coronary heart disease. Chin J Clin Rehabil. 2005;9(4):38–9.Google Scholar