Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart Disease Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM)
Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart Disease Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM)
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DOI：
10.1001/archinternmed.2010.510
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发表时间：
2011-01-24
影响因子：
--
通讯作者：
Svardsudd, Kurt
中科院分区：
文献类型：
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作者：
Gulliksson, Mats;Burell, Gunilla;Svardsudd, Kurt
背景资料：心理社会因素与心血管疾病（CVD）发病率和死亡率的风险增加独立相关，但心理社会因素干预对CVD的影响尚不确定。我们进行了一项随机对照临床试验的认知行为疗法（CBT），以衡量其对CVD recurrence.Methods的影响：这项研究包括362名女性和男性75岁或以下的人出院后，冠心病事件在过去的12个月内。患者随机接受传统护理（参考组，170例患者）或传统护理加CBT计划（干预组，192例患者），重点是压力管理，在1年内进行20次两小时的会议。每次CBT会议的平均出席率为85%。结果变量为全因死亡率、因复发性心血管疾病住院和复发性急性心肌梗死。结果：在平均94个月的随访中，干预组的致命性和非致命性首次复发性心血管疾病事件的发生率降低了41（风险比[95%置信区间]，0.59 [0.42-0.83]; P= 0.002），复发性急性心肌梗死减少45%（0.55 [0.36-0.85]; P= 0.007），调整其他影响结果的变量后，与参照组相比，全因死亡率低28%（0.72 [0.40-1.30]; P= 0.28），但无显著性差异。在CBT组中，干预组出勤率和结果之间存在强烈的剂量反应效应。在第一个2年的后续行动中，有没有显着的组间差异，在传统的危险factors.Conclusions：CBT干预计划降低复发性心血管疾病和复发性急性心肌梗死的风险。这可能对冠心病患者的二级预防计划有影响。
Background: Psychosocial factors are independently associated with increased risk of cardiovascular disease(CVD) morbidity and mortality, but the effects of psychosocial factor intervention on CVD are uncertain. We performed a randomized controlled clinical trial of cognitive behavioral therapy (CBT) to measure its effects on CVD recurrence.Methods: The study included 362 women and men 75 years or younger who were discharged from the hospital after a coronary heart disease event within the past 12 months. Patients were randomized to receive traditional care (reference group, 170 patients) or traditional care plus a CBT program (intervention group, 192 patients), focused on stress management, with 20 two-hour sessions during 1 year. Median attendance at each CBT session was 85%. Outcome variables were all-cause mortality, hospital admission for recurrent CVD, and recurrent acute myocardial infarction.Results: During a mean 94 months of follow-up, the intervention group had a 41% lower rate of fatal and non-fatal first recurrent CVD events (hazard ratio [95% confidence interval], 0.59 [0.42-0.83]; P=.002), 45% fewer recurrent acute myocardial infarctions (0.55 [0.36-0.85]; P=.007), and a nonsignificant 28% lower all-cause mortality (0.72 [0.40-1.30]; P=.28) than the reference group after adjustment for other outcome-affecting variables. In the CBT group there was a strong dose-response effect between intervention group attendance and outcome. During the first 2 years of follow-up, there were no significant group differences in traditional risk factors.Conclusions: A CBT intervention program decreases the risk of recurrent CVD and recurrent acute myocardial infarction. This may have implications for secondary preventive programs in patients with coronary heart disease.