Efficacy of an online psychological intervention for patients with ischemic heart disease targeting anxiety and depression: a randomized controlled trial (eMindYourHeart)

Background There is a strong association between mental health and ischemic heart disease (IHD), and anxiety and depression are prevalent in 20-30% of patients with IHD. Anxiety and depression in patients with IHD are associated with decreased health-related quality of life and adherence to medical treatment as well as increased healthcare costs and mortality. To mitigate the burden on patients and society it is crucial to treat these mental conditions concurrently with the cardiac disease. Online psychological treatment is an innovative and contemporary approach on the rise within cardiac care. Purpose To evaluate the efficacy of an online psychological intervention plus usual cardiac rehabilitation (CR), compared with usual CR alone, on depression in patients with IHD and comorbid depression or anxiety. Methods We conducted a multi-center, randomized, parallel-group, controlled, unblinded, superiority trial, randomizing 198 patients with IHD and comorbid anxiety or depression. The patients were allocated 1:1 to usual CR versus usual CR plus intervention. The primary outcome was the group difference in depression from baseline to 3 months follow-up as measured with the Hospital Anxiety and Depression Scale (Score range from 0-21 with higher scores indicating worse symptoms of anxiety and depression, respectively). Analysis were based on the intention-to-treat population and differences between groups were estimated using least-squares means with 95% confidence intervals (CI). The intervention (Table 1) consisted of guided online psychological treatment and has been developed specifically with and for patients with IHD and comorbid anxiety and depression. Results Patients had a mean age of 60.1 years (Standard deviation 9.8) and 125 (63%) were men. At 3 months follow-up, the usual CR group had a mean reduction in depression score of –0.80 while the usual CR plus intervention group had a mean reduction in depression score of -4.30, entailing a group difference for depression of -3.50 (95% CI -4.56 - -2.45; p<0.01). For anxiety, the usual CR group had a mean reduction in scores of -1.47 while the usual CR plus intervention group had a mean reduction in scores of -4.95, resulting in a group difference of -3.48 (95% CI -4.52 - -2.44; p<0.01) at 3 months follow-up (Table 2). Conclusion Among patients with IHD and comorbid anxiety or depression, the eMindYourHeart intervention plus usual CR resulted in statistically significant reductions in depression compared to usual CR alone. Long-term follow-up is needed to evaluate efficacy over time.