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Long-term effects of a multimodal behavioral intervention on myocardial perfusion--a randomized controlled trial
Christian Albus1, Peter Theissen, Martin Hellmich
1Department of Psychosomatics and Psychotherapy, University of Cologne, 50924, Cologne, Germany. christian.albus@uk-koeln.de
Insights
Behavioral interventions improve myocardial perfusion and reduce cardiac events in stable coronary heart disease (CHD) patients. This study shows long-term benefits beyond standard care for CHD prognosis.
Area of Science:
- Cardiology
- Behavioral Medicine
- Preventive Cardiology
Background:
- Advances in drug therapy for coronary heart disease (CHD) necessitate evaluating the added value of behavioral interventions.
- The impact of behavioral interventions on the prognosis of patients with clinically stable CHD requires further investigation.
Purpose of the Study:
- To assess the effects of a multimodal behavioral intervention on myocardial perfusion (MP) and cardiac events in stable CHD patients.
- To compare the outcomes of behavioral intervention plus standard care against standard care alone in patients with stable CHD.
Main Methods:
- Seventy-seven patients with stable CHD were randomized into two groups: behavioral intervention plus standard care (INT) or standard care alone (CO).
- Myocardial perfusion (MP) was evaluated using Thallium SPECT scans at baseline and at 2, 3, and 7 years.
- Cardiac events including myocardial infarction (MI), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) were recorded.
Main Results:
- A significantly better course of MP was observed in the intervention group (INT) compared to the control group (CO) over time (ANOVA p = 0.001).
- This improvement in MP was also significant in patients who did not undergo subsequent PCI or CABG (ANOVA p = 0.002).
- The incidence of cardiac events was significantly lower in the INT group (6 events) compared to the CO group (14 events) (log rank test p = .047).
Conclusions:
- A multimodal behavioral intervention offers additional long-term benefits for myocardial perfusion in patients with stable CHD.
- Behavioral interventions, when combined with standard cardiologic care, lead to a significant reduction in cardiac events for stable CHD patients.
Background:
Recent advances in drug therapy question as to the additional impact behavioral interventions may have on the prognosis of patients with clinically stable coronary heart disease (CHD).
Purpose:
The aim of the study was to evaluate the effects of a multimodal, behavioral intervention on myocardial perfusion (MP) and cardiac events, compared to standardized cardiologic care, in patients with stable CHD.
Methods:
Seventy-seven CHD patients (age 54.2 +/- 6.9 years, male 87%) were randomly assigned to a behavioral intervention plus standardized cardiologic care (INT, n = 39) or standardized cardiologic care alone (CO, n = 38). MP was assessed by (201)Thallium MP-scintigrams (SPECT) at baseline, after 2, 3, and 7 years, respectively. Subsequent cardiac events (MI, PCI, CABG) were assessed using the cardiologists' charts.
Results:
Sixty-five patients (84%) completed the study. In all patients, the course of MP was significantly better in INT analysis of variance (ANOVA group x time p = 0.001); this was also true for patients without subsequent PCI/CABG (ANOVA group x time p = 0.002). Incidence of cardiac events was significantly associated with INT (6 vs. 14; log rank test p = .047).
Conclusion:
The study suggests additional long-term benefits of a behavioral intervention on myocardial perfusion and cardiac events in patients with stable CHD compared to standardized cardiologic care only.