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Efficacy of psychological interventions on psychological outcomes in coronary artery disease: systematic review and meta-analysis

Published online by Cambridge University Press:  06 April 2020

Inés Magán Open the ORCID record for Inés Magán [Opens in a new window] ,
Laura Casado ,
Rosa Jurado-Barba Open the ORCID record for Rosa Jurado-Barba [Opens in a new window] ,
Haley Barnum ,
Marta M. Redondo ,
Adrian V. Hernandez Open the ORCID record for Adrian V. Hernandez [Opens in a new window]  and
Héctor Bueno Open the ORCID record for Héctor Bueno [Opens in a new window]
Inés Magán*
Affiliation:
Department of Psychology, Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, Spain
Laura Casado
Affiliation:
Department of Psychology, Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, Spain
Rosa Jurado-Barba
Affiliation:
Department of Psychology, Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, Spain Instituto de Investigación Biomédica del Hospital 12 de Octubre (Imas12), Madrid, Spain
Haley Barnum
Affiliation:
Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
Marta M. Redondo
Affiliation:
Department of Psychology, Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, Spain
Adrian V. Hernandez
Affiliation:
Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA Vicerrectorado de Investigacion, Universidad San Ignacio de Loyola (USIL), Lima, Peru
Héctor Bueno
Affiliation:
Instituto de Investigación Biomédica del Hospital 12 de Octubre (Imas12), Madrid, Spain Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain Multidisciplinary Translational Cardiovascular Research Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
*
Author for correspondence: Inés Magán, E-mail: imagan@ucjc.edu
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Abstract

Background

The benefits of cognitive-behavioral treatment (CBT) and positive psychology therapy (PPT) in patients with cardiovascular disease are still not well defined. We assessed the efficacy of CBT and PPT on psychological outcomes in coronary artery disease (CAD) patients.

Methods

Randomized controlled trials evaluating CBT or PPT in CAD patients published until May 2018 were systematically analyzed. Primary outcomes were depression, stress, anxiety, anger, happiness, and vital satisfaction. Random effects meta-analyses using the inverse variance method were performed. Effects were expressed as standardized mean difference (SMD) or mean differences (MD) with their 95% confidence intervals (CIs); risk of bias was assessed with the Cochrane tool.

Results

Nineteen trials were included (n = 1956); sixteen evaluated CBT (n = 1732), and three PPT (n = 224). Compared with control groups, depressive symptoms (13 trials; SMD −0.80; 95% CI −1.33 to −0.26), and anxiety (11 trials; SMD −1.26; 95% CI −2.11 to −0.41) improved after the PI, and depression (6 trials; SMD −2.08; 95% CI −3.22 to −0.94), anxiety (5 trials; SMD −1.33; 95% CI −2.38 to −0.29), and stress (3 trials; SMD −3.72; 95% CI −5.91 to −1.52) improved at the end of follow-up. Vital satisfaction was significantly increased at follow-up (MD 1.30, 0.27, 2.33). Non-significant effects on secondary outcomes were found. Subgroup analyses were consistent with overall analyses.

Conclusion

CBT and PPT improve several psychological outcomes in CAD patients. Depression and anxiety improved immediately after the intervention while stress and vital satisfaction improve in the mid-term. Future research should assess the individual role of CBT and PPT in CAD populations.

Keywords

Cognitive-behavioral treatmentcoronary artery diseasemeta-analysispositive psychology therapypsychological interventionpsychological outcomes
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 11 , August 2021 , pp. 1846 - 1860
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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