Key result
Mental health treatments and cardiac rehabilitation reduced CHD events and depression, but only cardiac rehabilitation reduced total mortality (ARR 0.016; 95% CI 0.005 to 0.027).
Why the study?
Do mental health treatments and cardiac rehabilitation reduce secondary events and improve depression in patients with coronary heart disease?
Meta-Analysis
Do mental health treatments and cardiac rehabilitation reduce secondary events and improve depression in patients with coronary heart disease?
Mental health treatments and cardiac rehabilitation both improve depression and reduce CHD events in patients with coronary heart disease, but only cardiac rehabilitation reduces total mortality.
Supports cardiac rehabilitation prioritization in CHD secondary prevention for mortality benefit; confirms mental health treatments reduce events and depression but not death.
OBJECTIVE: To quantify the efficacy of mental health (antidepressants & psychotherapies) and cardiac rehabilitation treatments for improving secondary event risk and depression among patients with coronary heart disease (CHD). METHODS: Using meta-analytic methods, we evaluated mental health and cardiac rehabilitation therapies for a) reducing secondary events and 2) improving depression severity in patients with CHD. Key word searches of PubMed and Psychlit databases and previous reviews identified relevant trials. RESULTS: Eighteen mental health trials evaluated secondary events and 22 trials evaluated depression reduction. Cardiac rehabilitation trials for the same categories numbered 17 and 13, respectively. Mental health treatments did not reduce total mortality (absolute risk reduction [ARR] = -0.001, confidence interval [95% CI] = -0.016 to 0.015; number needed to treat [NNT] = ∞), showed moderate efficacy for reducing CHD events (ARR = 0.029, 95% CI = 0.007 to 0.051; NNT = 34), and a medium effect size for improving depression (Cohen d = 0.297). Cardiac rehabilitation showed similar efficacy for treating depression (d = 0.23) and reducing CHD events (ARR = 0.017, 95% CI = 0.007 to 0.026; NNT = 59) and reduced total mortality (ARR = 0.016, 95% CI = 0.005 to 0.027; NNT = 63). CONCLUSIONS: Among patients with CHD, mental health treatments and cardiac rehabilitation may each reduce depression and CHD events, whereas cardiac rehabilitation is superior for reducing total mortality risk. The results support a continued role for mental health treatments and a larger role for mental health professionals in cardiac rehabilitation.
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Rutledge et al. (2013) conducted a meta-analysis in Coronary heart disease (CHD). Mental health treatments and cardiac rehabilitation was evaluated on Secondary events and depression severity (ARR 0.029, 95% CI 0.007 to 0.051). Mental health treatments and cardiac rehabilitation reduced CHD events and depression, but only cardiac rehabilitation reduced total mortality (ARR 0.016; 95% CI 0.005 to 0.027).
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