Article

Background Although psychological interventions are recommended for the
management of coronary heart disease (CHD), there remains considerable
uncertainty regarding their effectiveness. Design Systematic review and
meta-analysis of randomised controlled trials (RCTs) of psychological
interventions for CHD. Methods The Cochrane Central Register of Controlled
Trials, MEDLINE, EMBASE, CINAHL and PsycINFO were searched to April 2016.
Retrieved papers, systematic reviews and trial registries were hand-searched. We
included RCTs with at least 6 months of follow-up, comparing the direct effects
of psychological interventions to usual care for patients following myocardial
infarction or revascularisation or with a diagnosis of angina pectoris or CHD
defined by angiography. Two authors screened titles for inclusion, extracted data
and assessed risk of bias. Studies were pooled using random effects meta-analysis
and meta-regression was used to explore study-level predictors. Results
Thirty-five studies with 10,703 participants (median follow-up 12 months) were
included. Psychological interventions led to a reduction in cardiovascular
mortality (rfcelative risk 0.79, 95% confidence interval [CI] 0.63 to 0.98),
although no effects were observed for total mortality, myocardial infarction or
revascularisation. Psychological interventions improved depressive symptoms
(standardised mean difference [SMD] -0.27, 95% CI -0.39 to -0.15), anxiety (SMD
-0.24, 95% CI -0.38 to -0.09) and stress (SMD -0.56, 95% CI -0.88 to -0.24)
compared with controls. Conclusions We found that psychological intervention
improved psychological symptoms and reduced cardiac mortality for people with
CHD. However, there remains considerable uncertainty regarding the magnitude of
these effects and the specific techniques most likely to benefit people with
different presentations of CHD.

Langue : ANGLAIS