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Cochrane Database of Systematic Reviews

Psychological interventions for coronary heart disease

Overview of attention for article published in this source, August 2011
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Title
Psychological interventions for coronary heart disease
Published by
John Wiley & Sons, Ltd, August 2011
DOI 10.1002/14651858.cd002902.pub3
Pubmed ID
Authors

Whalley, Ben, Rees, Karen, Davies, Philippa, Bennett, Paul, Ebrahim, Shah, Liu, Zulian, West, Robert, Moxham, Tiffany, Thompson, David R, Taylor, Rod S

Abstract

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

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 81 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Spain 4 5%
United States 2 2%
United Kingdom 2 2%
South Africa 2 2%
Germany 1 1%
Norway 1 1%
Sweden 1 1%
Portugal 1 1%
Mexico 1 1%
Other 3 4%
Unknown 63 78%

Demographic breakdown

Readers by professional status Count As %
Student > Master 64 79%
Student > Ph. D. Student 61 75%
Researcher 54 67%
Student > Bachelor 47 58%
Student > Doctoral Student 28 35%
Other 87 107%
Readers by discipline Count As %
Medicine and Dentistry 123 152%
Psychology 118 146%
Nursing and Health Professions 23 28%
Social Sciences 13 16%
Agricultural and Biological Sciences 7 9%
Other 38 47%