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A meta-analysis of mental health treatments and cardiac rehabilitation for improving clinical outcomes and depression among patients with coronary heart disease.

Abstract

OBJECTIVE

To quantify the efficacy of mental health (antidepressants & psychotherapies) and cardiac rehabilitation treatments for improving secondary event risk and depression among patients with coronary heart disease (CHD).

METHODS

Using meta-analytic methods, we evaluated mental health and cardiac rehabilitation therapies for a) reducing secondary events and 2) improving depression severity in patients with CHD. Key word searches of PubMed and Psychlit databases and previous reviews identified relevant trials.

RESULTS

Eighteen mental health trials evaluated secondary events and 22 trials evaluated depression reduction. Cardiac rehabilitation trials for the same categories numbered 17 and 13, respectively. Mental health treatments did not reduce total mortality (absolute risk reduction [ARR] = -0.001, confidence interval [95% CI] = -0.016 to 0.015; number needed to treat [NNT] = ∞), showed moderate efficacy for reducing CHD events (ARR = 0.029, 95% CI = 0.007 to 0.051; NNT = 34), and a medium effect size for improving depression (Cohen d = 0.297). Cardiac rehabilitation showed similar efficacy for treating depression (d = 0.23) and reducing CHD events (ARR = 0.017, 95% CI = 0.007 to 0.026; NNT = 59) and reduced total mortality (ARR = 0.016, 95% CI = 0.005 to 0.027; NNT = 63).

CONCLUSIONS

Among patients with CHD, mental health treatments and cardiac rehabilitation may each reduce depression and CHD events, whereas cardiac rehabilitation is superior for reducing total mortality risk. The results support a continued role for mental health treatments and a larger role for mental health professionals in cardiac rehabilitation.

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  • Authors+Show Affiliations

    ,

    Psychology Service (116B), VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA. Thomas.rutledge@va.gov

    , ,

    Source

    Psychosomatic medicine 75:4 2013 May pg 335-49

    MeSH

    Antidepressive Agents
    Clinical Trials as Topic
    Coronary Disease
    Depression
    Depressive Disorder
    Exercise Therapy
    Female
    Humans
    Male
    Program Evaluation
    Psychotherapy
    Randomized Controlled Trials as Topic
    Secondary Prevention
    Survivors
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis

    Language

    eng

    PubMed ID

    23630306

    Citation

    Rutledge, Thomas, et al. "A Meta-analysis of Mental Health Treatments and Cardiac Rehabilitation for Improving Clinical Outcomes and Depression Among Patients With Coronary Heart Disease." Psychosomatic Medicine, vol. 75, no. 4, 2013, pp. 335-49.
    Rutledge T, Redwine LS, Linke SE, et al. A meta-analysis of mental health treatments and cardiac rehabilitation for improving clinical outcomes and depression among patients with coronary heart disease. Psychosom Med. 2013;75(4):335-49.
    Rutledge, T., Redwine, L. S., Linke, S. E., & Mills, P. J. (2013). A meta-analysis of mental health treatments and cardiac rehabilitation for improving clinical outcomes and depression among patients with coronary heart disease. Psychosomatic Medicine, 75(4), pp. 335-49. doi:10.1097/PSY.0b013e318291d798.
    Rutledge T, et al. A Meta-analysis of Mental Health Treatments and Cardiac Rehabilitation for Improving Clinical Outcomes and Depression Among Patients With Coronary Heart Disease. Psychosom Med. 2013;75(4):335-49. PubMed PMID: 23630306.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A meta-analysis of mental health treatments and cardiac rehabilitation for improving clinical outcomes and depression among patients with coronary heart disease. AU - Rutledge,Thomas, AU - Redwine,Laura S, AU - Linke,Sarah E, AU - Mills,Paul J, Y1 - 2013/04/29/ PY - 2013/5/1/entrez PY - 2013/5/1/pubmed PY - 2013/12/18/medline KW - Depression KW - cardiac rehabilitation KW - coronary heart disease KW - mental health KW - meta-analysis SP - 335 EP - 49 JF - Psychosomatic medicine JO - Psychosom Med VL - 75 IS - 4 N2 - OBJECTIVE: To quantify the efficacy of mental health (antidepressants & psychotherapies) and cardiac rehabilitation treatments for improving secondary event risk and depression among patients with coronary heart disease (CHD). METHODS: Using meta-analytic methods, we evaluated mental health and cardiac rehabilitation therapies for a) reducing secondary events and 2) improving depression severity in patients with CHD. Key word searches of PubMed and Psychlit databases and previous reviews identified relevant trials. RESULTS: Eighteen mental health trials evaluated secondary events and 22 trials evaluated depression reduction. Cardiac rehabilitation trials for the same categories numbered 17 and 13, respectively. Mental health treatments did not reduce total mortality (absolute risk reduction [ARR] = -0.001, confidence interval [95% CI] = -0.016 to 0.015; number needed to treat [NNT] = ∞), showed moderate efficacy for reducing CHD events (ARR = 0.029, 95% CI = 0.007 to 0.051; NNT = 34), and a medium effect size for improving depression (Cohen d = 0.297). Cardiac rehabilitation showed similar efficacy for treating depression (d = 0.23) and reducing CHD events (ARR = 0.017, 95% CI = 0.007 to 0.026; NNT = 59) and reduced total mortality (ARR = 0.016, 95% CI = 0.005 to 0.027; NNT = 63). CONCLUSIONS: Among patients with CHD, mental health treatments and cardiac rehabilitation may each reduce depression and CHD events, whereas cardiac rehabilitation is superior for reducing total mortality risk. The results support a continued role for mental health treatments and a larger role for mental health professionals in cardiac rehabilitation. SN - 1534-7796 UR - https://www.unboundmedicine.com/medline/citation/23630306/A_meta_analysis_of_mental_health_treatments_and_cardiac_rehabilitation_for_improving_clinical_outcomes_and_depression_among_patients_with_coronary_heart_disease_ L2 - http://Insights.ovid.com/pubmed?pmid=23630306 DB - PRIME DP - Unbound Medicine ER -