Psychological interventions for coronary heart disease
Whalley, Ben, Rees, Karen, Davies, Philippa, Bennett, Paul, Ebrahim, Shah, Liu, Zulian, West, Robert, Moxham, Tiffany, Thompson, David R. and Taylor, Rod. (2011) Psychological interventions for coronary heart disease. Cochrane Database of Systematic Reviews (No.8). CD002902. ISSN 1469-493XFull text not available from this repository.
Official URL: http://dx.doi.org/10.1002/14651858.CD002902
Psychological symptoms are strongly associated with coronary heart disease (CHD), and many psychological treatments are offered following cardiac events or procedures.
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.
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.
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 aminimum 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 (beta = -0.32, p = 0.03) were more effective than other interventions. In contrast, interventions which (2) aimed to educate patients about cardiac risk factors (beta = 0.23, p = 0.03), (3) included client-led discussion and emotional support as core therapeutic components (beta = 0.31, p < 0.01), or (4) included family members in the treatment process (beta = 0.26, p < 0.01) were significantly less effective.
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.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
|Divisions:||Faculty of Medicine > Warwick Medical School|
|Library of Congress Subject Headings (LCSH):||Coronary heart disease, Coronary heart disease -- Patients -- Psychology, Coronary heart disease -- Psychological aspects, Psychotherapy|
|Journal or Publication Title:||Cochrane Database of Systematic Reviews|
|Publisher:||John Wiley & Sons Ltd.|
|Book Title:||Cochrane Database of Systematic Reviews|
|Access rights to Published version:||Restricted or Subscription Access|
|Funder:||British Heart Foundation (BHF), Economic and Social Research Council (Great Britain) (ESRC), National Institute for Health Research (Great Britain) (NIH)|
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