Psychological interventions for coronary heart disease: Cochrane systematic review and meta-analysis

Suzanne Richards, Lindsey Anderson, Caroline Jenkinson, Ben Whalley, Karen Rees, Philippa Davies, Paul Bennett, Zulian Liu, Robert West, David Thompson, Rod Taylor

Research output: Contribution to journalArticle (Academic Journal)peer-review

56 Citations (Scopus)
292 Downloads (Pure)

Abstract

Background
Although psychological interventions are recommended for the management of coronary heart disease (CHD), there remains considerable uncertainty regarding their effectiveness.

Design
Systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for CHD.

Methods
The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and PsycINFO were searched to April 2016. Retrieved papers, systematic reviews and trial registries were hand-searched. We included RCTs with at least 6 months of follow-up, comparing the direct effects of psychological interventions to usual care for patients following myocardial infarction or revascularisation or with a diagnosis of angina pectoris or CHD defined by angiography. Two authors screened titles for inclusion, extracted data and assessed risk of bias. Studies were pooled using random effects meta-analysis and meta-regression was used to explore study-level predictors.

Results
Thirty-five studies with 10,703 participants (median follow-up 12 months) were included. Psychological interventions led to a reduction in cardiovascular mortality (rfcelative risk 0.79, 95% confidence interval [CI] 0.63 to 0.98), although no effects were observed for total mortality, myocardial infarction or revascularisation. Psychological interventions improved depressive symptoms (standardised mean difference [SMD] –0.27, 95% CI –0.39 to –0.15), anxiety (SMD –0.24, 95% CI –0.38 to –0.09) and stress (SMD –0.56, 95% CI –0.88 to –0.24) compared with controls.

Conclusions
We found that psychological intervention improved psychological symptoms and reduced cardiac mortality for people with CHD. However, there remains considerable uncertainty regarding the magnitude of these effects and the specific techniques most likely to benefit people with different presentations of CHD.
Original languageEnglish
Pages (from-to)247-259
Number of pages13
JournalEuropean Journal of Preventive Cardiology
Volume25
Issue number3
Early online date7 Dec 2017
DOIs
Publication statusPublished - 1 Feb 2018

Keywords

  • Cardiac morbidity
  • anxiety
  • depression
  • mortality
  • psychological intervention
  • Randomised controlled trial
  • stress
  • Systematic Review

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