Psychological interventions for coronary heart disease (Review)

摘要: Background: Psychological symptoms are strongly associated with coronary heart disease (CHD), and many psychological treatments offered following cardiac events or procedures. Objectives: Update the existing Cochrane review to (1) determine independent effects of interventions in patients CHD (principal outcome measures included total cardiac‐related mortality, morbidity, depression, anxiety) (2) explore study‐level predictors impact these interventions. Search methods: The original searched Controleed Trials Register (CCTR, Issue 4, 2001), MEDLINE, EMBASE, PsycINFO, CINAHL December 2001. This was updated by searching Central Controlled (CENTRAL), MEDLINE PsycINFO from 2001 January 2009. In addition, we reference lists papers, expert advice sought for update review. Selection criteria: Randomised controlled trials compared usual care, administered trained staff. Only studies estimating effect component a minimum follow‐up six months. Adults specific diagnosis CHD. Data collection analysis: Titles abstracts all references screened eligibility two reviewers independently; data extracted lead author checked second reviewer. Authors contacted where possible obtain missing information. Main results: There no strong evidence that intervention reduced deaths, risk revascularisation, non‐fatal infarction. Amongst smaller group reporting mortality there modest positive (relative risk: 0.80 (95% CI 0.64 1.00)). Furthermore, did result small/moderate improvements standardised mean difference (SMD): ‐0.21 ‐0.35, ‐0.08) anxiety, SMD: –0.25 ‐0.48 –0.03). Results indicated some small‐study bias, though results other outcomes not. Meta regression analyses revealed four significant on depression were found: an aim treat type‐A behaviours (s = ‐0.32, p 0.03) more effective than interventions. contrast, which aimed educate about factors 0.23, 0.03), (3) client‐led discussion emotional support as core therapeutic components 0.31, < 0.01), (4) family members treatment process 0.26, 0.01) significantly less effective. Authors' conclusions: appear treating patients. Uncertainly remains regarding subgroups who would benefit most characteristics successful