April 30, 2013
View Full PaperA Meta-Analysis of Mental Health Treatments and Cardiac Rehabilitation for Improving Clinical Outcomes and Depression Among Patients With Coronary Heart Disease
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).
Study Design
Type
Meta-Analysis
Structured PICO
Do mental health treatments and cardiac rehabilitation reduce secondary events and improve depression in patients with coronary heart disease?
P
Population
Patients with coronary heart disease (CHD) from multiple trials (18 mental health trials for secondary events, 22 for depression; 17 cardiac rehab trials for events, 13 for depression)
I
Intervention
Mental health treatments (antidepressants and psychotherapies) and cardiac rehabilitation
O
Outcome
Secondary events (CHD events, total mortality) and depression severityhard clinical
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.
Main Result
Effect estimate: ARR 0.029 (95% CI 0.007 to 0.051)
Abstract
OBJECTIVE: To quantify the efficacy of mental health (antidepressants 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.