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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

Rutledge, Thomas PhD; Redwine, Laura S. PhD; Linke, Sarah E. PhD, MPH; Mills, Paul J. PhD

doi: 10.1097/PSY.0b013e318291d798

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.

From the VA San Diego Healthcare System (T.R.), San Diego, California; and Departments of Psychiatry (T.R., L.S.R., P.J.M.) and Family and Preventive Medicine (S.E.L.), University of California, San Diego, California.

Address correspondence and reprint requests to Thomas Rutledge, PhD, ABPP, Psychology Service (116B), VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail:

Received for publication March 29, 2012; revision received December 11, 2012.

Copyright © 2013 by American Psychosomatic Society
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