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Psychological interventions for coronary heart disease
Open accessAbstract
BACKGROUND: Psychological symptoms are strongly associated with coronary heart disease (CHD), and many psychological treatments are offered following cardiac events or procedures. OBJECTIVES: Update the existing Cochrane review to (1) determine the independent effects of psychological interventions in patients with CHD (principal outcome measures included total or cardiac-related mortality, cardiac morbidity, depression, and anxiety) and (2) explore study-level predictors of the impact of these interventions. SEARCH STRATEGY: The original review searched Cochrane Controleed Trials Register (CCTR, Issue 4, 2001), MEDLINE, EMBASE, PsycINFO, and CINAHL to December 2001. This was updated by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, PsycINFO and CINAHL from 2001 to January 2009. In addition, we searched reference lists of papers, and expert advice was sought for the original and update review. SELECTION CRITERIA: Randomised controlled trials of psychological interventions compared to usual care, administered by trained staff. Only studies estimating the independent effect of the psychological component with a minimum follow-up of six months. Adults with specific diagnosis of CHD. DATA COLLECTION AND ANALYSIS: Titles and abstracts of all references screened for eligibility by two reviewers independently; data extracted by the lead author and checked by a second reviewer. Authors contacted where possible to obtain missing information. MAIN RESULTS: There was no strong evidence that psychological intervention reduced total deaths, risk of revascularisation, or non-fatal infarction. Amongst a smaller group of studies reporting cardiac mortality there was a modest positive effect of psychological intervention (relative risk: 0.80 (95% CI 0.64 to 1.00)). Furthermore, psychological intervention did result in small/moderate improvements in depression, standardised mean difference (SMD): -0.21 (95% CI -0.35, -0.08) and anxiety, SMD: -0.25 (95% CI -0.48 to -0.03). Results for mortality indicated some evidence of small-study bias, though results for other outcomes did not. Meta regression analyses revealed four significant predictors of intervention effects on depression were found: (1) an aim to treat type-A behaviours (ß = -0.32, p = 0.03) were more effective than other interventions. In contrast, interventions which (2) aimed to educate patients about cardiac risk factors (ß = 0.23, p = 0.03), (3) included client-led discussion and emotional support as core therapeutic components (ß = 0.31, p < 0.01), or (4) included family members in the treatment process (ß = 0.26, p < 0.01) were significantly less effective. AUTHORS' CONCLUSIONS: Psychological treatments appear effective in treating psychological symptoms of CHD patients. Uncertainly remains regarding the subgroups of patients who would benefit most from treatment and the characteristics of successful interventions.
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“Two recent meta-analyses and two recent RCTs 86,199,343,348 have also shown their additional impact on the prevention of clinical CHD, especially in patients who achieved their behavioural goals.349”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [343]
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“This approach can reduce mood symptoms and enhance health-related quality of life, although evidence for a definite beneficial effect on cardiac endpoints is inconclusive.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [343]
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Metadata
- Authors
- Whalley, B., Rees, K., Davies, P., Bennett, P., Ebrahim, S., Liu, Z., West, R., Moxham, T., Thompson, D. R., & Taylor, R. S.
- Affiliations
- University of Bristol (GB)
- University of Warwick (GB)
- Cardiff University (GB)
- London School of Hygiene & Tropical Medicine (GB)
- University of Exeter (GB)
- Florida Atlantic University (US)
- Australian Catholic University (AU)
- Peninsula College of Medicine and Dentistry (GB)
- ORCID
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- John Wiley & Sons, Ltd
- Published
- 2011-08-10
- Issue
- 8
- Pages
- CD002902-CD002902
- ISSN
- 1361-6137 (ISSN-L)
- OpenAlex
- W2340820090
- Cited by
- 194
- References
- 180
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 6 · 2023: 7 · 2022: 12 · 2021: 8 · 2020: 9 · 2019: 14 · 2018: 9 · 2017: 16 · 2016: 25 · 2015: 20 · 2014: 19 · 2013: 23 · 2012: 12
- Type
- reference entry
- Language
- en
- Update notices
- new_version (2017-04-28)
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Funders
- Economic and Social Research Council (ES/G022593/1)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- coronary artery disease, psychological intervention, cardiac mortality, depression, anxiety, myocardial infarction, Type A behavior pattern, cardiac rehabilitation
- MeSH terms
- Aged, Anxiety, Coronary Disease, Depression, Female, Humans, Male, Myocardial Infarction, Myocardial Revascularization, Psychotherapy, Reoperation
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