Linden W, Stossel C, Maurice J
Department of Psychology, University of British Columbia, Vancouver.
Arch Intern Med. 1996 Apr 8;156(7):745-52.
Narrative review strategies and meta-analyses have shown that drug treatment and exercise rehabilitation regimens can reduce psychological distress and postmyocardial infarction mortality and recurrence.
To question whether the addition of psychosocial interventions improves the outcome of a standard rehabilitation regimen for patients with coronary artery disease.
We performed a statistical meta-analysis of 23 randomized controlled trials that evaluated the additional impact of psychosocial treatment of rehabilitation from documented coronary artery disease. Anxiety, depression, biological risk factors, mortality, and recurrence of cardiac events were the clinical end points that were studied. Mortality data were available from 12 studies, and recurrence data were available from 10 of the 23 studies.
The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. The psychosocially treated patients showed greater reductions in psychological distress, systolic blood pressure, heart rate, and cholesterol level (with effect size differences of -0.34 [corrected], -0.24, -0.38, and -1.54, respectively). Patients who did not receive psychosocial treatment showed greater mortality and cardiac recurrence rates during the first 2 years of follow-up with log-adjusted odds ratios of 1.70 for mortality (95% confidence interval [CI], 1.09 to 2.64) and 1.84 for recurrence (CI, 1.12 to 2.99).
The addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychological distress, and some biological risk factors. The benefits were clearly evident during the first 2 years and were weaker thereafter. At the clinical level, it is recommended to include routinely psychosocial treatment components in cardiac rehabilitation. The findings also suggest an urgent need to identify the specific, most effective types of psychosocial interventions via controlled research.
叙述性综述策略和荟萃分析表明，药物治疗和运动康复方案可减轻心理困扰，并降低心肌梗死后的死亡率和复发率。
探讨心理社会干预措施的加入是否能改善冠心病患者标准康复方案的效果。
我们对23项随机对照试验进行了统计荟萃分析，这些试验评估了心理社会治疗对已确诊冠心病患者康复的额外影响。研究的临床终点包括焦虑、抑郁、生物学危险因素、死亡率和心脏事件复发率。12项研究提供了死亡率数据，23项研究中的10项提供了复发数据。
这些研究共评估了2024例接受心理社会治疗的患者和1156例对照受试者。接受心理社会治疗的患者在心理困扰、收缩压、心率和胆固醇水平方面的降低幅度更大（效应大小差异分别为-0.34[校正后]、-0.24、-0.38和-1.54）。未接受心理社会治疗的患者在随访的前两年中死亡率和心脏复发率更高，死亡率的对数调整比值比为1.70（95%置信区间[CI]，1.09至2.64），复发率的对数调整比值比为1.84（CI，1.12至2.99）。
在标准心脏康复方案中加入心理社会治疗可降低死亡率和发病率、减轻心理困扰并降低一些生物学危险因素。这些益处在前两年明显，之后则减弱。在临床层面，建议在心脏康复中常规纳入心理社会治疗成分。研究结果还表明迫切需要通过对照研究确定具体、最有效的心理社会干预类型。
