Efficacy of psychological interventions on clinical outcomes of coronary artery disease: Systematic review and meta-analysis
Abstract
Objectives Psychological factors influence clinical outcomes in patients with coronary artery disease (CAD). Therefore, psychological interventions (PIs) may have beneficial effects in these patients. We evaluated the efficacy of PIs based on cognitive-behavioral therapy (CBT) and positive psychology therapy (PPT) on clinical and laboratory outcomes in CAD.Methods Randomized controlled trials evaluating CBT or PPT in CAD patients published until May 2020 were systematically reviewed and analyzed. Primary outcomes were all-cause mortality, cardiovascular mortality, any cardiovascular event, myocardial infarction (MI), stroke, coronary revascularization, angina, and readmission. Random effects meta-analyses using the inverse variance method were performed. Effects were expressed as risk ratios (RR) or standardized mean difference (SMD) with 95% confidence intervals (CIs).Results Twenty-five trials were included (n = 8119); 22 evaluating the effects of multi-component CBT (n = 7909), and three PPT (n = 210). Thirteen RCTs were at high risk of bias due to limitations in randomization or blinding. Compared with control groups any cardiovascular event (RR 0.82; 0.70 to 0.97; 5 studies), MI (RR 0.72; 0.52 to 0.98; 9 studies), and angina duration and intensity (SMD -0.64; -0.98 to -0.30; 4 studies; and -0.64; -1.17 to -0.11; 2 trials) were significantly reduced with PIs at the end of follow-up. PIs had no effect on other primary outcomes, laboratory or anthropometrical results and presented a moderate to high heterogeneity.Conclusions CBT- and PPT-based PIs reduce the risk of cardiovascular events, MI and angina in patients with CAD. Future research should assess the individual role of CBT and PPT in CAD populations.
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People living with chronic conditions including mental illness, heart disease or acquired brain injury have tremendous capacity to improve the determinants of wellbeing.
“This claim is supported by findings that people living with chronic conditions including mental illness (Goodman et al., 2018), heart disease (Magán et al., 2021) or acquired brain injury (Wilkie et al., 2021) have tremendous capacity to improve the determinants of wellbeing (see also Kemp et al., 2022).”
From The Complex Construct of Wellbeing and the Role of Vagal Function (2022) · cites this paper as Magán et al., 2021
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“However, there seems to be a comparable amount of evidence that finds no benefits on car - diac mortality, with the side note that only very few cardiac deaths were registered across the follow-up period [48, 52].”
Influential
- Authors
- Magán, I., Jurado-Barba, R., Casado, L., Barnum, H., Jeon, A., Hernandez, A. V., & Bueno, H.
- Affiliations
- Camilo José Cela University (ES)
- University of Connecticut (US)
- Spanish National Centre for Cardiovascular Research (ES)
- Corresponding author
- Magán, Inés
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2022-02
- Volume
- 153
- Pages
- 110710
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W4200513843
- Cited by
- 39
- References
- 55
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 10 · 2023: 6 · 2022: 2
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Depósito Digital e-UCJC (submittedVersion)
- 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, cognitive behavioral therapy, cardiovascular events, myocardial infarction, angina pectoris, cardiovascular mortality, all-cause mortality, coronary revascularization, hospital readmission, stroke
- MeSH terms
- Psychosocial Intervention, Coronary Artery Disease, Humans, Myocardial Infarction, Cognitive Behavioral Therapy
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