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Psychological interventions for coronary heart disease.

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Richards, Suzanne H, Anderson, Lindsey, Jenkinson, Caroline E, Whalley, Ben, Rees, Karen, Davies, Philippa, Bennett, Paul, Liu, Zulian +3 more·2017·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd002902.pub4PMC PMC6478177
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Abstract

BACKGROUND: Coronary heart disease (CHD) is the most common cause of death globally, although mortality rates are falling. Psychological symptoms are prevalent for people with CHD, and many psychological treatments are offered following cardiac events or procedures with the aim of improving health and outcomes. This is an update of a Cochrane systematic review previously published in 2011. OBJECTIVES: To assess the effectiveness of psychological interventions (alone or with cardiac rehabilitation) compared with usual care (including cardiac rehabilitation where available) for people with CHD on total mortality and cardiac mortality; cardiac morbidity; and participant-reported psychological outcomes of levels of depression, anxiety, and stress; and to explore potential study-level predictors of the effectiveness of psychological interventions in this population. SEARCH METHODS: We updated the previous Cochrane Review searches by searching the following databases on 27 April 2016: CENTRAL in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO). SELECTION CRITERIA: We included randomised controlled trials (RCTs) of psychological interventions compared to usual care, administered by trained staff, and delivered to adults with a specific diagnosis of CHD. We selected only studies estimating the independent effect of the psychological component, and with a minimum follow-up of six months. The study population comprised of adults after: a myocardial infarction (MI), a revascularisation procedure (coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI)), and adults with angina or angiographically defined coronary artery disease (CAD). RCTs had to report at least one of the following outcomes: mortality (total- or cardiac-related); cardiac morbidity (MI, revascularisation procedures); or participant-reported levels of depression, anxiety, or stress. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts of all references for eligibility. A lead review author extracted study data, which a second review author checked. We contacted study authors to obtain missing information. MAIN RESULTS: This review included 35 studies which randomised 10,703 people with CHD (14 trials and 2577 participants added to this update). The population included mainly men (median 77.0%) and people post-MI (mean 65.7%) or after undergoing a revascularisation procedure (mean 27.4%). The mean age of participants within trials ranged from 53 to 67 years. Overall trial reporting was poor, with around a half omitting descriptions of randomisation sequence generation, allocation concealment procedures, or the blinding of outcome assessments. The length of follow-up ranged from six months to 10.7 years (median 12 months). Most studies (23/35) evaluated multifactorial interventions, which included therapies with multiple therapeutic components. Ten studies examined psychological interventions targeted at people with a confirmed psychopathology at baseline and two trials recruited people with a psychopathology or another selecting criterion (or both). Of the remaining 23 trials, nine studies recruited unselected participants from cardiac populations reporting some level of psychopathology (3.8% to 53% with depressive symptoms, 32% to 53% with anxiety), 10 studies did not report these characteristics, and only three studies excluded people with psychopathology.Moderate quality evidence showed no risk reduction for total mortality (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.77 to 1.05; participants = 7776; studies = 23) or revascularisation procedures (RR 0.94, 95% CI 0.81 to 1.11) with psychological therapies compared to usual care. Low quality evidence found no risk reduction for non-fatal MI (RR 0.82, 95% CI 0.64 to 1.05), although there was a 21% reduction in cardiac mortality (RR 0.79, 95% CI 0.63 to 0.98). There was also low or very low quality evidence that psychological interventions improved participant-reported levels of depressive symptoms (standardised mean difference (SMD) -0.27, 95% CI -0.39 to -0.15; GRADE = low), anxiety (SMD -0.24, 95% CI -0.38 to -0.09; GRADE = low), and stress (SMD -0.56, 95% CI -0.88 to -0.24; GRADE = very low).There was substantial statistical heterogeneity for all psychological outcomes but not clinical outcomes, and there was evidence of small-study bias for one clinical outcome (cardiac mortality: Egger test P = 0.04) and one psychological outcome (anxiety: Egger test P = 0.012). Meta-regression exploring a limited number of intervention characteristics found no significant predictors of intervention effects for total mortality and cardiac mortality. For depression, psychological interventions combined with adjunct pharmacology (where deemed appropriate) for an underlying psychological disorder appeared to be more effective than interventions that did not (β = -0.51, P = 0.003). For anxiety, interventions

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  • Richards et al. found no evidence that cognitive behavioral therapy in CHD patients was more effective than other investigated interventions.

    “Richards et al. (16) also found no evidence that the currently used interventions of cognitive behavioral therapy in CHD patients, which is the gold standard in the treatment of anxiety and depression in general, were more effective than the other ones investigated.”

    From Metacognitive Short-Term Intervention in Patients With Mental Disorders Following Cardiovascular Events (2022) · cites this paper as [16]

    In “Agreements and disagreements with other studies or reviews” (page unavailable), the review says it found no evidence that interventions with cognitive components or those targeting behavioural change were more effective. That supports the general comparison, but the review does not report a distinct comparison of cognitive behavioural therapy as a whole against the other interventions investigated. (LLM, conf=0.86)

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  • A recent systematic review reported that psychological interventions in CVD, such as CBT, have small effects on depression in patients with CVD.

    “A recent systematic review has reported that psychological interventions in CVD, such as cognitive behavioral therapy (CBT), have small effects on depression in patients with CVD [5].”

    From An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial (2019) · cites this paper as [5]

  • The effects of iCBT on depression are stronger than the small effect (standardized mean difference 0.27) reported in the latest systematic review of psychological interventions for depression in patients with CVD.

    “The effects on depression are stronger than the reported small effect (standardized mean difference of 0.27) from the latest systematic review of psychological interventions for depression in patients with CVD [5].”

    From An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial (2019) · cites this paper as [5]

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Research works printed but not linked: 3

  1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
  2. singl$ adj blind$).tw. 58. assign$.tw. 59. allocat$.tw. 60. volunteer$.tw. 61. control*.tw. 62. "2000".md. 63. 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 or 60 or 61 or 62 64. 50 and 63 65. (2015* or 2016*).up. 66. 64 and 65 CINAHL 2015 S67 S54 OR S66 DRT: edited and approved the final manuscript. DRT was a co-author on the second version (2011) of this Cochrane Review. RST: advised on study selection, data extraction, risk of bias assessment, and analyses, and edited and approved the final manuscript.
  3. RST was a co-author on the second version (2011) of this Cochrane Review.

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Authors
Richards, S. H., Anderson, L., Jenkinson, C. E., Whalley, B., Rees, K., Davies, P., Bennett, P., Liu, Z., West, R., Thompson, D. R., & Taylor, R. S.
Affiliations
  • University of Leeds (GB)
  • University of Exeter (GB)
  • University of Plymouth (GB)
  • University of Warwick (GB)
  • University of Bristol (GB)
  • Swansea University (GB)
  • University of Birmingham (GB)
  • Cardiff University (GB)
  • Queen's University Belfast (GB)
  • MRC/CSO Social and Public Health Sciences Unit (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2017-04-28
Volume
2021
Issue
2
Pages
CD002902-CD002902
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd002902.pub4
PMC
PMC6478177
OpenAlex
W1738399877
Cited by
571
References
333
Citations by year
2026: 9 · 2025: 19 · 2024: 28 · 2023: 23 · 2022: 45 · 2021: 52 · 2020: 40 · 2019: 43 · 2018: 37 · 2017: 17 · 2016: 23 · 2015: 21 · 2014: 26 · 2013: 29 · 2012: 24
FWCI
5.24
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Research Portal (Queen's University Belfast) (acceptedVersion, other-oa)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • PEARL (University of Plymouth) (submittedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • Royal Devon and Exeter NHS Foundation Trust
  • National Institute for Health and Care Research (12/189/06, NF-SI-0514-10155)
  • University of Exeter
  • Health Technology Assessment Programme (12/189/06)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
coronary artery disease, psychological intervention, cardiac rehabilitation, myocardial infarction, revascularization, depression, anxiety, stress, cardiac mortality, cardiac morbidity, predictors of treatment effectiveness, patient-reported outcomes, quality of life
MeSH terms
Aged, Anxiety, Cause of Death, Coronary Disease, Depression, Female, Humans, Male, Middle Aged, Myocardial Infarction, Myocardial Revascularization, Psychotherapy, Reoperation, Stress, Psychological, Randomized Controlled Trials as Topic

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