Does psychological treatment reduce mortality and event recurrence in cardiac patients?
Psychological treatment added to usual care reduces short-term mortality in cardiac patients, with benefits driven primarily by men and when initiated at least 2 months post-event.
Previous reports of the effectiveness of psychological treatments (PTs) for cardiac patients reveal inconsistent results. We determined overall effects and gender differences. Eligible studies were randomized controlled trials, containing a PT arm. The authors identified 43 relevant randomized trials; 23 reported mortality data for 9856 patients. The odds-ratio (OR) for all-cause mortality at follow-up of 2 years or less, comparing PT plus usual care vs. usual care only, was OR 0.72 95% confidence interval (CI) 0.56–0.94, but weakened with longer follow-up (OR 0.89; 95% CI 0.80–1.10). Mortality benefits only applied to men (OR 0.73, 95% CI 0.57–1.00; OR 1.01; 95% CI 0.87–1.72 for women). Trials initiating treatment at least 2 months after a cardiac event showed greater mortality benefits than those initiating treatment right after the event (OR 0.28; 95% CI 0.11–0.70 vs. OR 0.87; 95% CI 0.86–1.15, respectively). Mortality benefits due to PT were achieved despite small concomitant changes in negative affect. PT of cardiac patients reduces mortality and event recurrence. The mortality benefits appeared only in men even after controlling for age differences. The timing for the initiation of PT may be a critical mediating variable for mortality outcomes.
Linden et al. (2007) studied this question.