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

Journal article

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 six 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

35 studies with 10,703 participants (median follow-up 12 months) were included. Psychological interventions led to a reduction in cardiovascular mortality (relative 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 from different presentations of CHD.

Authors: Richards, SH; Anderson, L; Jenkinson, CE; Whalley, B; Rees, K

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: SAGE Publications
• Journal: European Journal of Preventive Cardiology
• Volume: 25
• Issue: 3
• Pages: 247-259
• Publication date: 2017-12-07
• Acceptance date: 2017-10-10
• DOI: 10.1177/2047487317739978
• EISSN: 2047-4881
• ISSN: 2047-4873
• Pmid: 29212370
• Language: English
• Keywords: randomised controlled trial; anxiety; systematic review; *keyword*; psychological intervention; cardiac morbidity; Journal Article; depression; stress; mortality
• Subjects: *subject*