International Journal of Behavioral Medicine

, Volume 21, Issue 1, pp 109–121 | Cite as

Psychological Interventions for Coronary Heart Disease: Cochrane Systematic Review and Meta-analysis

Article

Abstract

Background

Depression and anxiety are common in cardiac patients, and psychological interventions may also be used as part of general cardiac rehabilitation programs.

Purpose

This study aims to estimate effects of psychological interventions on mortality and psychological symptoms in this group, updating an existing Cochrane Review.

Method

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.

Results

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.

Conclusion

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.

Keywords

Coronary heart disease Psychological interventions Cardiac rehabilitation Secondary prevention Systematic review Meta-analysis 

References

  1. 1.
    Chung MC, Berger Z, Jones R, Rudd H. Posttraumatic stress disorder and general health problems following myocardial infarction (Post-MI PTSD) among older patients: the role of personality. Int J Geriatr Psychiatr. 2006;21(12):1163–74.CrossRefGoogle Scholar
  2. 2.
    Krishnan KRR, Delong M, Kraemer H, et al. Comorbidity of depression with other medical diseases in the elderly. Biol Psychiatry. 2002;52(6):559–88.PubMedCrossRefGoogle Scholar
  3. 3.
    Diener E, Chan MY. Happy people live longer: subjective well-being contributes to health and longevity. Appl Psychol Health Well-Being. 2011;3(1):1–43.CrossRefGoogle Scholar
  4. 4.
    Stice E. Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull. 2002;128(5):825.PubMedCrossRefGoogle Scholar
  5. 5.
    Hopko DR, Mullane CM. Exploring the relation of depression and overt behavior with daily diaries. Behav Res Ther. 2008;46(9):1085–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Halaris A. Comorbidity between depression and cardiovascular disease. Int Angiol. 2009;28(2):92–9.PubMedGoogle Scholar
  7. 7.
    Hemingway H, Marmot M. Psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies. BMJ. 1999;318(7196):1460–7.PubMedCrossRefGoogle Scholar
  8. 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. 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
  10. 10.
    Mendall MA, Patel P, Asante M, et al. Relation of serum cytokine concentrations to cardiovascular risk factors and coronary heart disease. Heart. 1997;78(3):273–7.PubMedGoogle Scholar
  11. 11.
    Martin RA. Humor, laughter, and physical health: methodological issues and research findings. Psychol Bull. 2001;127(4):504.PubMedCrossRefGoogle Scholar
  12. 12.
    Pasic J, Levy WC, Sullivan MD. Cytokines in depression and heart failure. Psychosom Med. 2003;65(2):181–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Greaves C, Sheppard K, Abraham C, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Publ Health. 2011;11(1):119.CrossRefGoogle Scholar
  14. 14.
    Lespérance F, Frasure-Smith N. Depression in patients with cardiac disease: a practical review. J Psychosom Res. 2000;48:379–91.PubMedCrossRefGoogle Scholar
  15. 15.
    Jolly K, Bradley F, Sharp S, Smith H, Mant D. Follow-up care in general practice of patients with myocardial infarction or angina pectoris: initial results of the SHIP trial. Southampton Heart Integrated Care Project. Fam Pract. 1998;15(6):548–55.PubMedCrossRefGoogle Scholar
  16. 16.
    Black JL, Allison TG, Williams DE, Rummans TA, Gau GT. Effect of intervention for psychological distress on rehospitalization rates in cardiac rehabilitation patients. Psychosomatics. 1998;39(2):134–43.PubMedCrossRefGoogle Scholar
  17. 17.
    Burnett-Zeigler I, Zivin K, Ilgen M, et al. Depression treatment in older adult veterans. Am J Geriatr Psychiatr. 2010.Google Scholar
  18. 18.
    Cepoiu M, McCusker J, Cole MG, et al. Recognition of depression by non-psychiatric physicians—a systematic literature review and meta-analysis. J Gen Intern Med. 2008;23(1):25–36.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Welton NJ, Caldwell DM, Adamopoulos E, Vedhara K. Mixed treatment comparison meta-analysis of complex interventions: psychological interventions in coronary heart disease. Am J Epidemiol. 2009;169(9):1158.PubMedCrossRefGoogle Scholar
  20. 20.
    Rees K, Bennett P, West R, Davey SG, Ebrahim S. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev. 2004;2:CD002902.PubMedGoogle Scholar
  21. 21.
    DeBusk RF, Miller NH, Superko R, et al. A case-management system for coronary risk factor modification after acute myocardial infarction. Ann Intern Med. 1994;120:721–9.PubMedCrossRefGoogle Scholar
  22. 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
  23. 23.
    Fridlund B, Hogstedt B, Lidell E, Larsson PA. Recovery after myocardial infarction: effects of a caring rehabilitation programme. Scand J Caring Sci. 1991;5(1):23–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Linden W, Phillips MJ, Leclerc J. Psychological treatment of cardiac patients: a meta-analysis. Eur Hear J. 2007;28(24):2972–84.CrossRefGoogle Scholar
  25. 25.
    ENRICHD. Enhancing Recovery in Coronary Heart Disease (ENRICHD) study intervention: rationale and design. Psychosom Med. 2001;63(5):747–55.Google Scholar
  26. 26.
    Butler A, Chapman J, Forman E, Beck A. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17–31.PubMedCrossRefGoogle Scholar
  27. 27.
    Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Heal Psychol. 2008;27(3):379.CrossRefGoogle Scholar
  28. 28.
    Wilson C, Huston T, Koval J, et al. SCIRehab Project series: the psychology taxonomy. J Spinal Cord Med. 2009;32(3):319.PubMedGoogle Scholar
  29. 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. 30.
    Cochrane. Preferred method for handling continuous variables. 2003. Available at: http://heart.cochrane.org/resources-review-authors.
  31. 31.
    Follmann D, Elliot P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992;45:769–73.PubMedCrossRefGoogle Scholar
  32. 32.
    Hersen M, Hilsenroth MJ, Segal DL. Comprehensive handbook of psychological assessment. Hoboken: Wiley; 2004.Google Scholar
  33. 33.
    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple graphical test. BMJ. 1997;315:629–34.PubMedCrossRefGoogle Scholar
  34. 34.
    Brown MA, Munford AM, Munford PR. Behavior therapy of psychological distress in patients after myocardial infarction or coronary bypass. J Cardpulm Rehabil. 1993;13(3):201–10.CrossRefGoogle Scholar
  35. 35.
    Burgess AW, Lerner DJ, d’ Agostino RB, Vokonas PS. A randomized control trial of cardiac rehabilitation. Soc Sci Med. 1987;24(4):359–70.PubMedCrossRefGoogle Scholar
  36. 36.
    Cowan MJ, Pike KC, Kogan BH. Psychosocial nursing therapy following sudden cardiac arrest: impact on two-year survival. Nurs Res. 2001;50(2):68–76.PubMedCrossRefGoogle Scholar
  37. 37.
    Elderen-van-Kemenade T, Maes S, van-den Broek Y. Effects of a health education programme with telephone follow-up during cardiac rehabilitation. Br J Clin Psychol. 1994;33(3):367–78.PubMedCrossRefGoogle Scholar
  38. 38.
    Gallacher JEJ, Hopkinson CA, Bennett P, Burr ML, Elwood PC. Effect of stress management on angina. Psychol Heal. 1997;12(4):523–32.CrossRefGoogle Scholar
  39. 39.
    HofmanBang C, Lisspers J, Nordlander R, et al. Two-year results of a controlled study of residential rehabilitation for patients treated with percutaneous transluminal coronary angioplasty—a randomized study of a multifactorial programme. Eur Hear J. 1999;20(20):1465–74.CrossRefGoogle Scholar
  40. 40.
    Ibrahim MA, Feldman JG, Sultz HA, et al. Management after myocardial infarction: a controlled trial of the effect of group psychotherapy. Int J Psychiatry Med. 1974;5(3):253–68.PubMedCrossRefGoogle Scholar
  41. 41.
    Jones DA, West RR. Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial. BMJ. 1996;313(7071):1517–21.PubMedCrossRefGoogle Scholar
  42. 42.
    Oldenburg B, Perkins RJ, Andrews G. Controlled trial of psychological intervention in myocardial infarction. J Consult Clin Psychol. 1985;53(6):852–9.PubMedCrossRefGoogle Scholar
  43. 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
  44. 44.
    Friedman M, Thoresen CE, Gill JJ, et al. Feasibility of altering type A behaviour pattern after myocardial infarction. Circulation. 1982;66(1):83–92.PubMedCrossRefGoogle Scholar
  45. 45.
    Stern MJ, Gorman PA, Kaslow L. The group counseling v exercise therapy study. A controlled intervention with subjects following myocardial infarction. Arch Intern Med. 1983;143(9):1719–25.PubMedCrossRefGoogle Scholar
  46. 46.
    Van-Dixhoorn JJ, Duivenvoorden HJ. Effect of relaxation therapy on cardiac events after myocardial infarction: a 5-year follow-up study. J Cardpulm Rehabil. 1999;19(3):178–85.CrossRefGoogle Scholar
  47. 47.
    Appels A, Bar F, van der Pol G, et al. Effects of treating exhaustion in angioplasty patients on new coronary events: results of the randomized exhaustion intervention trial (EXIT). Psychosom Med. 2005;67(2):217–23.PubMedCrossRefGoogle Scholar
  48. 48.
    Claesson M, Birgander L, Lindahl B, et al. Women’s hearts: stress management for women with ischemic heart disease: explanatory analyses of a randomized controlled trial. J Cardpulm Rehabil. 2005;25(2):93–102.CrossRefGoogle Scholar
  49. 49.
    Koertge J, Janszky I, Sundin O, et al. Effects of a stress management program on vital exhaustion and depression in women with coronary heart disease: a randomized controlled intervention study. J Intern Med. 2008;263(3):281–93.PubMedCrossRefGoogle Scholar
  50. 50.
    Mayou R, Thompson D, Clements A, et al. Guideline-based early rehabilitation after myocardial infarction: a pragmatic randomised controlled trial. J Psychosom Res. 2002;52(2):89–95.PubMedCrossRefGoogle Scholar
  51. 51.
    McLaughlin T, Aupont O, Bambauer K, et al. Improving psychologic adjustment to chronic illness in cardiac patients: the role of depression and anxiety. J Gen Intern Med. 2005;20(12):1084–90.PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Michalsen A, Grossman P, Lehmann N, et al. Psychological and quality-of-life outcomes from a comprehensive stress reduction and lifestyle program in patients with coronary artery disease: results of a randomized trial. Psychother Psychosom. 2005;74(6):344–52.PubMedCrossRefGoogle Scholar
  53. 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
  54. 54.
    Sebregts EHWJ, Falger PRJ, Appels A, Kester ADM, Bär FWHM. Psychological effects of a short behavior modification program in patients with acute myocardial infarction or coronary artery bypass grafting: a randomized controlled trial. J Psychosom Res. 2005;58(5):417–24.PubMedCrossRefGoogle Scholar
  55. 55.
    Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO. Exercise treatment for depression: efficacy and dose response. Am J Prev Med. 2005;28(1):1–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Kuper H, Nicholson A, Kivimaki M, et al. Evaluating the causal relevance of diverse risk markers: horizontal systematic review. BMJ. 2009;339:b4265.PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    Carney RM, Freedland KE, Miller GE, Jaffe AS. Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosom Res. 2002;53:897–902.PubMedCrossRefGoogle Scholar
  58. 58.
    Jacobson NS, Dobson KS, Truax PA, et al. A component analysis of cognitive—behavioral treatment for depression. J Consult Clin Psychol. 1996;64(2):295–304.PubMedCrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2012

Authors and Affiliations

  • Ben Whalley
    • 1
  • David R. Thompson
    • 2
  • Rod S. Taylor
    • 3
  1. 1.School of PsychologyUniversity of PlymouthPlymouthUK
  2. 2.Cardiovascular Research Centre (CvRC)Australian Catholic UniversityMelbourneAustralia
  3. 3.Peninsula College of Medicine and DentistryUniversities of Exeter and PlymouthExeterUK

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