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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
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Psychological interventions for coronary heart disease
Suzanne H Richards1,2, Lindsey Anderson3, Caroline E Jenkinson2
1Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK, LS2 9LJ.
The Cochrane Database of Systematic Reviews
|April 29, 2017
Summary
Psychological interventions for coronary heart disease (CHD) did not reduce overall mortality or myocardial infarction rates. However, they did lower cardiac mortality and improve psychological symptoms like depression and anxiety, though evidence quality is low.
Area of Science:
- Cardiology and Psychological Medicine
- Systematic Review and Meta-Analysis
- Evidence-Based Medicine
Background:
- Coronary heart disease (CHD) remains a leading global cause of death, with psychological symptoms frequently observed in affected individuals.
- Psychological treatments are commonly administered post-cardiac events to enhance patient outcomes.
- This review is an update of a 2011 Cochrane systematic review on the topic.
Purpose of the Study:
- To evaluate the effectiveness of psychological interventions, with or without cardiac rehabilitation, compared to usual care for individuals with CHD.
- To assess impacts on total and cardiac mortality, cardiac morbidity, and psychological outcomes (depression, anxiety, stress).
- To identify potential predictors of psychological intervention effectiveness in CHD patients.
Main Methods:
- An updated systematic search of multiple databases (CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL) was conducted up to April 27, 2016.
- Included were randomized controlled trials (RCTs) of psychological interventions versus usual care in adults with CHD, with a minimum six-month follow-up.
- Data extraction and quality assessment were performed independently by two review authors.
Main Results:
- The review included 35 RCTs with 10,703 participants; moderate-quality evidence indicated no reduction in total mortality or revascularization procedures.
- Low-quality evidence suggested a reduction in cardiac mortality (21%) and improvements in depression, anxiety, and stress symptoms.
- Significant statistical heterogeneity was noted for psychological outcomes, and potential small-study bias was detected for cardiac mortality and anxiety.
Conclusions:
- Psychological treatments for CHD showed no effect on total mortality or revascularization but reduced cardiac mortality and alleviated psychological symptoms, albeit with considerable uncertainty.
- Uncertainty persists regarding which patients benefit most and the optimal intervention components.
- Future large-scale trials are needed to test specific psychological interventions and their targeted application in diverse CHD populations.
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