Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: results of the randomized controlled PSY-HEART trial

摘要: Placebo effects contribute substantially to outcome in most fields of medicine. While clinical trials typically try control or minimize these effects, the potential placebo mechanisms improve is rarely used. Patient expectations about treatment efficacy and are major that effects. We aimed optimize patients undergoing coronary artery bypass graft (CABG) surgery. In a prospective three-arm randomized trial with 6 month follow-up, 124 scheduled for CABG surgery were either brief psychological pre-surgery intervention (EXPECT); focusing on emotional support general advice, but not (SUPPORT); standard medical care (SMC). Interventions kept be feasible heart environment; “dose” therapy was identical both interventions. Primary disability 6 months after Secondary outcomes comprised further immunological variables. Patients EXPECT group showed significantly larger improvements (−12.6; −17.6 −7.5) than SMC (−1.9; −6.6 +2.7); SUPPORT (−6.7; −11.8 1.7) did differ from group. Comparing follow-up scores controlling baseline versus variable only revealed trend favor (P = 0.09). Specific advantages compared found mental quality life fitness work (hours per week). Both interventions induced less pronounced increases pro-inflammatory cytokine concentrations reflected by decreased interleukin-8 levels post-surgery changes lower interleukin-6 at follow-up. characterized great patient acceptability no adverse attributed them. Considering innovative nature this approach, replication larger, multicenter needed. Optimizing patients’ helps treatment. This implies making use has long-term highly invasive Further studies warranted generalize approach other Ethical approval study obtained IRB Medical School, University Marburg, registered ( NCT01407055 ) July 25, 2011.