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European Heart Journal Advance Access originally published online on November 5, 2007
European Heart Journal 2007 28(24):2972-2984; doi:10.1093/eurheartj/ehm504
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Psychological treatment of cardiac patients: a meta-analysis

Wolfgang Linden1,*,{dagger}, Melanie Jayne Phillips1 and Jocelyne Leclerc2

1 Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T 1Z4
2 Department of Psychology, University of Regina, Saskatchewan, Canada

Received 5 June 2007; revised 27 September 2007; accepted 4 October 2007; online publish-ahead-of-print 5 November 2007.

* Corresponding author: Tel: +1 604 822 4156; fax: +1 604 822 6923. E-mail address: wlinden{at}psych.ubc.ca

See page 2964 for the editorial comment on this article (doi:10.1093/eurheartj/ehm522)

Previous reports of the effectiveness of psychological treatments (PTs) for cardiac patients reveal inconsistent results. We determined overall effects and gender differences. Eligible studies were randomized controlled trials, containing a PT arm. The authors identified 43 relevant randomized trials; 23 reported mortality data for 9856 patients. The odds-ratio (OR) for all-cause mortality at follow-up of 2 years or less, comparing PT plus usual care vs. usual care only, was OR 0.72 [95% confidence interval (CI) 0.56–0.94], but weakened with longer follow-up (OR 0.89; 95% CI 0.80–1.10). Mortality benefits only applied to men (OR 0.73, 95% CI 0.57–1.00; OR 1.01; 95% CI 0.87–1.72 for women). Trials initiating treatment at least 2 months after a cardiac event showed greater mortality benefits than those initiating treatment right after the event (OR 0.28; 95% CI 0.11–0.70 vs. OR 0.87; 95% CI 0.86–1.15, respectively). Mortality benefits due to PT were achieved despite small concomitant changes in negative affect. PT of cardiac patients reduces mortality and event recurrence. The mortality benefits appeared only in men even after controlling for age differences. The timing for the initiation of PT may be a critical mediating variable for mortality outcomes.

Key Words: Cardiac rehabilitation • Stress management • Psychological therapy • Outcome • Mortality • Event recurrence • Depression • Distress

{dagger} W.L. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.


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