Ischaemic heart disease: Psychosocial interventions assist in reducing cardiac mortality

Clinical bottom line (level 1a)

  1. In patients with documented coronary heart disease, a psychosocial intervention in addition to usual rehabilitation improves mortality (OR=0.54)
Linden et al: Arch Intern Med ; : -
Expires March 2003

The study

Systematic review of all RCT of rehabilitation programmes with a formal psychosocial component of
  • Patients: established coronary artery disease
  • Outcome: mortality; biochemical measures; psychological measures



Articles found in not stated using Medline, not stated (search terms: not stated ) and searching reference lists; investigators NOT contacted

Selection criteria: all unconfounded RCTs comparing a psychosocial intervention to a control arm in patients with documented coronary artery disease (e.g. CABG/ prior MI)
Appraisal criteria: not stated
Articles excluded if: not stated

22 trials with true randomisation, one large quasi-randomised trial excluded from principle analysis. 18/23 trials exclusively post-MI patients

  • Odds ratios initially given as odds of HARM if NO TREATMENT is given
no significant heterogeneity noted

The evidence

Outcome Time to outcome OR
(95% CI)
Morbidity 2 years 0.54
(0.33 to 0.89)
Mortality 2 years 0.59
(0.37 to 0.91)

  • Psychological distress scores: mean effect size of -0.30 (SD 0.37) for treatment compared with -0.04 (SD 0.16) for control

Comments

  1. Study uses a variety of formal cognitive-behavioral programmes; it does not address intensity or duration with regard to efficacy

Citation

  1. Linden W, Stossel C, Maurice J: Psychosocial interventions for patients with coronary artery disease. A meta analysis.. Arch Intern Med ; : -
Contributor: Bob Phillips and Musab Hayatli, November 1999
Reviewer:

Clinical Question.
Patient in patients with established coronary artery disease
Intervention or Exposure psychosocial intervention as part of a rehabilitation program
Outcome cardiovascular morbidity or mortality