Psychological treatment of cardiac patients: a meta-analysis
Psychological treatment of cardiac patients: a meta-analysis
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DOI：
10.1093/eurheartj/ehm504
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发表时间：
2007-12-01
影响因子：
39.3
通讯作者：
Leclerc, Jocelyne
中科院分区：
文献类型：
--
作者：
Linden, Wolfgang;Phillips, Melanie Jayne;Leclerc, Jocelyne
以前的报告的心脏病患者的心理治疗（PT）的有效性揭示了不一致的结果。我们确定了总体效果和性别差异。符合条件的研究是随机对照试验，包含PT组。作者确定了43项相关的随机试验; 23项报告了9856例患者的死亡率数据。PT+常规治疗与仅常规治疗相比，随访2年或更短时间时全因死亡率的比值比（OR）为0.72 [95%置信区间（CI）0.56-0.94]，但随着随访时间的延长而减弱（OR 0.89; 95% CI 0.80-1.10）。死亡率获益仅适用于男性（女性OR 0.73，95% CI 0.57-1.00; OR 1.01; 95% CI 0.87-1.72）。在心脏事件发生后至少2个月开始治疗的试验显示，与事件发生后立即开始治疗的试验相比，死亡率获益更大（OR 0.28; 95% CI 0.11-0.70 vs. OR 0.87; 95% CI 0.86-1.15）。尽管伴随的负面影响变化很小，但由于PT而实现了死亡率获益。心脏病患者的PT可降低死亡率和事件复发率。即使在控制了年龄差异之后，死亡率的好处也只出现在男性身上。开始PT的时间可能是死亡率结局的关键中介变量。
Previous reports of the effectiveness of psychological treatments (PTs) for cardiac patients reveal inconsistent results. We determined overall effects and gender differences. Eligible studies were randomized controlled trials, containing a PT arm. The authors identified 43 relevant randomized trials; 23 reported mortality data for 9856 patients. The odds-ratio (OR) for all-cause mortality at follow-up of 2 years or less, comparing PT plus usual care vs. usual care only, was OR 0.72 [95% confidence interval (CI) 0.56-0.94], but weakened with longer follow-up (OR 0.89; 95% CI 0.80-1.10). Mortality benefits only applied to men (OR 0.73, 95% CI 0.57-1.00; OR 1.01; 95% CI 0.87-1.72 for women). Trials initiating treatment at least 2 months after a cardiac event showed greater mortality benefits than those initiating treatment right after the event (OR 0.28; 95% CI 0.11-0.70 vs. OR 0.87; 95% CI 0.86-1.15, respectively). Mortality benefits due to PT were achieved despite small concomitant changes in negative affect. PT of cardiac patients reduces mortality and event recurrence. The mortality benefits appeared only in men even after controlling for age differences. The timing for the initiation of PT may be a critical mediating variable for mortality outcomes.