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Psychological therapies for people with heart disease
Psychological therapies for people with heart disease
PEARLS No.
744
Clinical question
Are psychological therapies effective and safe in adults who have a diagnosis of coronary heart disease, heart failure or atrial fibrillation?
Bottom line
This review indicates that all types of psychological interventions, when pooled together and compared with no psychological intervention, probably result in a moderate reduction in depression and anxiety in adults with CHD or HF, and may result in a moderate improvement in mental health-related quality of life (but not physical HRQoL).
Meta-regression analyses showed that psychological interventions specifically targeting anxiety are probably more effective than non-targeted interventions, although further research studies are needed to substantiate this finding.
Intervention acceptability was generally good and there was no indication of adverse events, all-cause hospitalisation, cardiovascular morbidity (non-fatal myocardial infarction) or cardiovascular mortality being related to the psychological intervention.
Caveat
The overall completeness and applicability of the evidence is limited due to insufficient investigation or reporting of outcomes. There was also moderate to substantial heterogeneity across studies. As such, evidence of treatment effects warrants careful interpretation. No studies looked at adults with AF, and firm conclusions cannot be made about the effects of specific psychological interventions.
Context
Depression and anxiety occur frequently (with reported prevalence rates of approximately 40%) in individuals with CHD, HF or AF and are associated with a poor prognosis, such as decreased HRQoL and increased morbidity and mortality. Psychological interventions commonly include cognitive behavioural therapies and mindfulness-based stress reduction. They have been shown to reduce depression and anxiety in the general population, although the exact mechanism of action is not well understood. Further, their effects on psychological and clinical outcomes in patients with CHD, HF or AF are unclear.
Cochrane Systematic Review
Ski CF, et al. Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation. Cochrane Database Syst Rev 2024;4:CD013508. This review contains 21 trials with a total of 2591 participants.
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