A meta-analysis of clinical efficacy and quality of life of cognitive-behavioral therapy in acute coronary syndrome patients with anxiety and depression

Abstract

Background: Our study aims to evaluate the clinical efficacy and quality of life of cognitive-behavioral therapy (CBT) for patients who have acute coronary syndrome (ACS) with anxiety and depression.Methods: The databases of PubMed, Cochrane, and Web of science, as well as China journal full-text database, Wanfang database, and Weipu database, were systematically searched from the establishment of the database to February 29, 2020. The total effective rate of qualitative data was evaluated with a relative risk (RR) and 95% confidence interval (CI), and the quantitative data was evaluated with a standard mean difference (SMD) and 95% CI. Randomized controlled clinical trials of CBT for ACS were included. The RevMan5.3 and R3.5.1 software was used to analyze.Results: A total of 11 papers, including 1,259 patients, were included, including 639 patients in the CBT group and 620 in the control group. One article reported the total effective rate after three months of treatment with an RR of 1.48 (95% CI: 1.07, 2.06). A total of 3 articles reported the incidence of cardiovascular adverse events using the fixed effects model (I 2 =41%), and the incidence of cardiovascular adverse events in the CBT group was 0.39 times lower than that in the control group (95% CI: 0.2, 0.77). A total of 11 articles reported the score of depression using the random effects model (I 2 =93%), and the score of depression in the CBT group was significantly lower than that in the control group, with an SMD of −0.99 (95% CI: −1.44, −0.54). The score of anxiety was reported in 8 pieces of literature, and the randomized effect model estimated that the score of anxiety in the CBT group was significantly lower than that in the control group, with an SMD of −1.47 (95% CI: −1.98, −0.96). There was significant heterogeneity in the quality of life score, but it was not found that the quality of life score in the CBT group was significantly higher than that in the control group.Conclusions: After CBT intervention, ACS patients with anxiety and depression can significantly reduce the incidence of cardiovascular adverse events and significantly reduce scores of depression and anxiety, but they have not been found to have an advantage in improving quality of life.

A network meta-analysis of 12,116 individuals from randomized controlled trials in the treatment of depression after acute coronary syndrome

“…Statements from the American Heart Association (AHA) and the European Society of Cardiology (ESC) both identified post ACS depression to be a significant risk factor for cardiac morbidity and mortality [ 63 , 64 ], with recent consensus describing the importance of regular screening for depression in patients suffering from coronary artery disease with consideration of CBT and SSRIs for the treatment of their depression [ 65 ]. While previous meta-analysis has examined the effects of CBT [ 66 ] and the use of SSRIs [ 67 , 68 ] in treating depression after ACS, no study has done a ranking assessment between all the possible treatments for post-ACS depression. Thus, we add to these findings by (1) conducting a network meta-analysis between treatments (2) pooling the effects of intervention on clinical outcomes.…”