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Effectiveness of Cognitive Behavioral Therapy for Depression and Anxiety in Patients With Cardiovascular Disease

A Systematic Review and Meta-Analysis

Reavell, James, BMedSci; Hopkinson, Michael, BMedSci; Clarkesmith, Danielle, PhD; Lane, Deirdre A., PhD

doi: 10.1097/PSY.0000000000000626

Objective 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.

Methods 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).

Results 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 2 = 59%) and anxiety (SMD = −0.34, 95% CI = −0.65 to −0.03, p = .03, I 2 = 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 2 = 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.

Conclusions 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.

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.

Address correspondence to Deirdre A. Lane, PhD, University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Rd, Birmingham, B18 7QH, United Kingdom. E-mail:

Supplemental Content

Received for publication September 24, 2017; revision received July 2, 2018.

Copyright © 2018 by American Psychosomatic Society
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