Psychosocial Interventions for Patients With Heart Failure and Their Impact on Depression, Anxiety, Quality of Life, Morbidity, and Mortality: A Systematic Review and Meta-Analysis

Abstract

ObjectiveThe purpose of this systematic review and meta-analysis was to evaluate the ability of psychosocial interventions to reduce depression and anxiety, improve quality of life, and reduce hospitalization and mortality rates in patients with heart failure.MethodsStudies of psychosocial interventions published from 1970 to 2021 were identified through four databases (PubMed, Ovid MEDLINE, PsycINFO, Cochrane). Two authors independently conducted a focused analysis and reached a final consensus on the studies to include, followed by a quality check by a third author. A risk of bias assessment was conducted.ResultsTwenty-three studies were identified, but only 15 studies of mostly randomized controlled trials with a total of 1370 patients with heart failure were included in the meta-analysis. Interventions were either cognitive behavioral therapy (CBT) or stress management. The pooled intervention effect was in favor of the intervention for depression (combined difference in standardized mean change [DSMC]: −0.41; 95% confidence interval [CI] = −0.66 to −0.17; p = .001) and anxiety (combined DSMC: −0.33; 95% CI = −0.51 to −0.15; p < .001) but was only a trend for quality of life (combined DSMC: 0.14; 95% CI = −0.00 to 0.29; p = .053). Evidence was limited that interventions produced lower rates of hospitalization (5 of 5 studies showing a beneficial effect) or death (1 of 5 with a beneficial effect).ConclusionsCBT and stress management interventions significantly reduced depression and anxiety compared with control conditions. CBT significantly improved quality of life compared with controls, but stress management did not. Longer treatment duration seemed to be an important factor related to treatment success.

The Impact of Cardiac Devices on Patients’ Quality of Life—A Systematic Review and Meta-Analysis

“…Several reviews have reported on psychopathology among patients with cardiac arrhythmias [ 62 , 63 , 64 , 65 , 66 , 67 , 68 ]. Hereby, the prevalence of anxiety disorders and depressive symptoms is estimated to be approximately 20% in ICD patients according to a large meta-analysis from 2011 [ 6 ].…”

A meta-review of systematic reviews and meta-analyses on outcomes of psychosocial interventions in heart failure

“…The quality appraisal with AMSTAR-2 yielded five studies to have moderate quality (9)(10)(11)(12)(13), one study to have low quality (14) and one to be of critically low quality (15). The article with critically low quality had, for instance, not performed a risk-of-bias assessment of the individual articles which is consider a critical item in AMSTAR-2.…”

“…Two of the reviews included patients with CHF and comorbid depression or depressive symptoms (11,12). In the five meta-analyses post-intervention, four metaanalyses reported statistically significant reduction in depression with a small to moderate effect size (0.27-0.41) (9,10,12,14). One meta-analysis reported a non-significant result, however, the authors mentioned results that showed a trend for reduction in depression in the intervention group (15).…”

“…One meta-analysis reported a non-significant result, however, the authors mentioned results that showed a trend for reduction in depression in the intervention group (15). One meta-analyses also divided the meta-analyses for CBT and stress management intervention where both showed significant reductions in depression (CBT −0.37, 95% CI −0.70 to −0.05, p = 0.024, Stress management −0.51, 95% CI −0.83 to −0.19, p = 0.002) (9). Follow-up assessments showed inconsistent results where one meta-analysis had sustained reductions in depression after 3 months with a moderate effect size ( 12) and one meta-analysis could not show a sustained effect at last follow-up assessment (21.86 weeks ±14.65, range = 12-52 weeks) (10).…”

“…Three of the reviews reported anxiety as an outcome measure (9,10,13). Two meta-analyses showed statistically significant improvements in anxiety with a moderate effect size (0.33 and 0.49) (9, 10).…”