PSYCHOSOCIAL INTERVENTIONS FOR PATIENTS WITH CORONARY-ARTERY DISEASE - A METAANALYSIS

Background: Narrative review strategies and meta-analyses have shown t hat drug treatment and exercise rehabilitation regimens can reduce psy chological distress and postmyocardial infarction mortality and recurr ence. Objective: To question whether the addition of psychosocial inte rventions improves the outcome of a standard rehabilitation regimen fo r patients with coronary artery disease. Methods: We performed a stati stical meta-analysis of 23 randomized controlled trials that evaluated the additional impact of psychosocial treatment of rehabilitation fro m documented coronary artery disease. Anxiety, depression, biological risk factors, mortality, and recurrence of cardiac events were the cli nical end points that were studied. Mortality data were available from 12 studies, and recurrence data were available from 10 of the 23 stud ies. Results: The studies had evaluated 2024 patients who received psy chosocial treatment vs 1156 control subjects. The psychosocially creat ed patients showed greater reductions in psychological distress, systo lic blood pressure, heart rate, and cholesterol level (with effect siz e differences of 0.34, -0.24, -0.38, and -1.54, respectively). Patient s who did not receive psychosocial treatment showed greater mortality and cardiac recurrence rates during the first 2 years of follow-up wit h log-adjusted odds ratios of 1.70 for mortality (95% confidence inter val [CI], 1.09 to 2.64) and 1.84 for recurrence (CI, 1.12 to 2.99). Co nclusions: The addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychologica l distress, and some biological risk factors. The benefits were dearly evident during the first 2 years and were weaker thereafter. At the c linical level, it is recommended to include routinely psychosocial tre atment components in cardiac rehabilitation. The findings also suggest an urgent need to identify the specific, most effective types of psyc hosocial interventions via controlled research.