Key result
Adding psychosocial interventions to cardiac rehab reduces mortality by ~41% over two years.
Why the study?
It was uncertain whether adding psychosocial interventions to standard rehabilitation improves outcomes in patients with coronary artery disease.
Does the addition of psychosocial interventions reduce mortality and cardiac recurrence in patients with coronary artery disease undergoing standard rehabilitation?
Meta-Analysis (n=3,180)
Does the addition of psychosocial interventions reduce mortality and cardiac recurrence in patients with coronary artery disease undergoing standard rehabilitation?
Odds Ratio: 1.7 (95% CI 1.09–2.64)
Adding psychosocial interventions to standard cardiac rehabilitation significantly reduces mortality, cardiac recurrence, and psychological distress in patients with coronary artery disease.
Supports adding psychosocial interventions to cardiac rehabilitation; confirms mortality and recurrence reduction in CAD.
BACKGROUND: Narrative review strategies and meta-analyses have shown that drug treatment and exercise rehabilitation regimens can reduce psychological distress and postmyocardial infarction mortality and recurrence. OBJECTIVE: To question whether the addition of psychosocial interventions improves the outcome of a standard rehabilitation regimen for patients with coronary artery disease. METHODS: We performed a statistical meta-analysis of 23 randomized controlled trials that evaluated the additional impact of psychosocial treatment of rehabilitation from documented coronary artery disease. Anxiety, depression, biological risk factors, mortality, and recurrence of cardiac events were the clinical end points that were studied. Mortality data were available from 12 studies, and recurrence data were available from 10 of the 23 studies. RESULTS: The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. The psychosocially treated patients showed greater reductions in psychological distress, systolic blood pressure, heart rate, and cholesterol level (with effect size differences of -0.34 [corrected], -0.24, -0.38, and -1.54, respectively). Patients who did not receive psychosocial treatment showed greater mortality and cardiac recurrence rates during the first 2 years of follow-up with log-adjusted odds ratios of 1.70 for mortality (95% confidence interval [CI], 1.09 to 2.64) and 1.84 for recurrence (CI, 1.12 to 2.99). CONCLUSIONS: The addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychological distress, and some biological risk factors. The benefits were clearly evident during the first 2 years and were weaker thereafter. At the clinical level, it is recommended to include routinely psychosocial treatment components in cardiac rehabilitation. The findings also suggest an urgent need to identify the specific, most effective types of psychosocial interventions via controlled research.
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W. Linden (1996) conducted a meta-analysis in coronary artery disease (n=3,180). Psychosocial interventions vs. Standard rehabilitation regimen without psychosocial treatment was evaluated on Mortality (OR 1.70, 95% CI 1.09-2.64). Adding psychosocial interventions to standard cardiac rehabilitation reduced mortality (control vs intervention OR 1.70; 95% CI 1.09-2.64) and cardiac recurrence during the first 2 years.
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