From the College of Medical and Dental Sciences (Reavell, Hopkinson), University of Birmingham, Birmingham, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences (Clarkesmith, Lane), City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; and Aalborg Thrombosis Research Unit (Lane), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Psychosom Med. 2018 Oct;80(8):742-753. doi: 10.1097/PSY.0000000000000626.
Depression and anxiety are highly prevalent in patients with cardiovascular disease (CVD) and influence their mental well-being and CVD prognosis. The primary objective was to assess the effectiveness of cognitive behavioral therapy (CBT) for depression and anxiety in patients with CVD. Secondary objectives were to assess the impact of CBT on cardiovascular mortality, cardiovascular events, patient satisfaction, and quality of life.
MEDLINE, PsycINFO, CINAHL, CENTRAL, and alternative sources were searched for randomized controlled trials and observational studies with a control. Studies were required to assess CBT in coronary heart disease, acute coronary syndrome, atrial fibrillation, or postmyocardial infarction patients, with anxiety and/or depression. Studies were independently screened by two reviewers and critically appraised using the Cochrane Risk of Bias tool. The random-effects model was used to pool standardized mean differences (SMD).
Twelve randomized controlled trials were included. At follow-up, depression (SMD = -0.35, 95% confidence interval [CI] = -0.52 to -0.17, p < .001, I = 59%) and anxiety (SMD = -0.34, 95% CI = -0.65 to -0.03, p = .03, I = 71%) scores were significantly lower in CBT patients compared with controls. Change in mental health quality of life (SF-12) was also significantly greater for CBT patients, compared with controls (mean difference = 3.62, 95% CI = 0.22 to 7.02, p = .04, I = 0%). No differences in patient satisfaction or cardiovascular events were evident between CBT and control groups. Among the study reports included in this meta-analysis, data specific to cardiovascular mortality were not reported.
Cognitive behavioral therapy seems to be an effective treatment for reducing depression and anxiety in patients with CVD and should be considered in standard clinical care.
抑郁和焦虑在心血管疾病（CVD）患者中非常普遍，影响他们的心理健康和 CVD 预后。主要目的是评估认知行为疗法（CBT）对 CVD 患者抑郁和焦虑的疗效。次要目标是评估 CBT 对心血管死亡率、心血管事件、患者满意度和生活质量的影响。
对 MEDLINE、PsycINFO、CINAHL、CENTRAL 和其他替代资源进行了检索，以查找有对照的随机对照试验和观察性研究。研究需要评估 CBT 在冠心病、急性冠状动脉综合征、心房颤动或心肌梗死后患者中的应用，同时评估焦虑和/或抑郁情况。研究由两位评审员独立筛选，并使用 Cochrane 偏倚风险工具进行批判性评估。使用随机效应模型汇总标准化均数差值（SMD）。
共纳入 12 项随机对照试验。随访时，CBT 组的抑郁评分（SMD = -0.35，95%置信区间 [CI] = -0.52 至 -0.17，p <.001，I = 59%）和焦虑评分（SMD = -0.34，95% CI = -0.65 至 -0.03，p =.03，I = 71%）均显著低于对照组。与对照组相比，CBT 组的心理健康生活质量（SF-12）评分也显著提高（平均差异 = 3.62，95% CI = 0.22 至 7.02，p =.04，I = 0%）。CBT 组和对照组在患者满意度或心血管事件方面没有差异。在本荟萃分析中包含的研究报告中，没有报告心血管死亡率的具体数据。
认知行为疗法似乎是治疗 CVD 患者抑郁和焦虑的有效方法，应在标准临床护理中考虑。
