The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and blinding) and by inconsistency (variability in results across studies).
A Cochrane review [Abstract] 1 included 35 studies with a total of 10 703 subjects. The review examined the effectiveness of psychological interventions (alone or with cardiac rehabilitation) compared with usual care (including cardiac rehabilitation where available) for people with coronary heart disease (CHD). Psychological therapies compared to usual care did not reduce total mortality (RR 0.90, 95% CI 0.77 to 1.05; 23 studies, n=7 776), revascularisation procedures (RR 0.94, 95% CI 0.81 to 1.11), or non-fatal myocardial infarctions (RR 0.82, 95% CI 0.64 to 1.05). There was a 21% reduction in cardiac mortality (RR 0.79, 95% CI 0.63 to 0.98), and psychological interventions improved participant-reported levels of depressive symptoms (SMD -0.27, 95% CI -0.39 to -0.15, statistical heterogeneity, I2 =69%), anxiety (SMD -0.24, 95% CI -0.38 to -0.09), and stress (SMD -0.56, 95% CI -0.88 to -0.24; statistical heterogeneity, I2 =86%).
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