Randomized Trial of Mindfulness-Based Stress Reduction in Cardiac Patients Eligible for Cardiac Rehabilitation

Abstract

Currently, exercise-based cardiac rehabilitation (CR) is the only recommended secondary prevention strategy for cardiac patients that attempts to tackle stress and psychosocial wellbeing, but it is under-utilized and lacks a comprehensive curriculum for this purpose; hence there is a critical gap to address psychosocial needs of cardiac patients after an event. Mindfulness-based stress reduction (MBSR) has shown benefits in the general population but its role in cardiac patients is not clear. We conducted a pilot randomized controlled trial (RCT) of MBSR in CR-eligible cardiac patients during their initial year of recovery. Patients were allocated 2:1 (intervention:control) to an 8-week MBSR group intervention or usual care. Standard measures of depression, anxiety, perceived stress, health related quality of life (HRQOL), blood pressure, biomarkers (lipids, HbA1c, CRP) and 24-hour Holter monitoring were obtained at baseline, 3- and 9-months post-randomization. Sub-group analyses were performed for participants with at least mild depression (PHQ-9 ≥ 5). 47 patients [mean age 58.6 years; 38% female; 77% white] were enrolled in 2 cohorts. 87% of MBSR patients completed the intervention; study retention was >95% at each follow-up visit. At 3 months, compared to controls, MBSR patients showed improvements in depression [p = 0.01] and anxiety [p = 0.04] with a similar trend in HRQOL [p = 0.06]. The MBSR group showed greater improvement or less worsening of most CV risk factors, with an attenuation of treatment effects at 9 months. Participants with at PHQ-9 scores ≥5 at baseline showed greater improvement in psychosocial and CV outcomes, that persisted at 9 months. MBSR is a safe and well received secondary prevention strategy. This pilot RCT provides preliminary evidence of MBSR’s potential to improve short term psychosocial well-being in cardiac patients during their first year of recovery.

Association of the 2020 US Presidential Election With Hospitalizations for Acute Cardiovascular Conditions

“… 15 Mindfulness, meditation, yoga, and other relaxation techniques have also been suggested as ways to reduce stress. 30 , 31 , 32 A meta-analysis 31 of 42 studies that included yoga and mindfulness-based stress reduction techniques reported associations with lower evening and waking cortisol levels, lower systolic blood pressure, resting heart rate, heart rate variability, fasting blood glucose, cholesterol, and low-density lipoprotein-cholesterol compared with active controls.…”

Utilization of Mind–Body Intervention for Integrative Health Care of COVID-19 Patients and Survivors

“…In an RCT involving patients undergoing cardiac rehabilitation following acute coronary events, 3 months of yoga practice showed no difference in FBG compared to the usual care ( n = 60) [ 34 ]. In another study for cardiac patients, no change was found in HbA1c level after 8 weeks of MBSR program ( n = 47) [ 35 ].…”

Web- and Mindfulness-Based Intervention to Prevent Chronic Pain After Cardiac Surgery: Protocol for a Pilot Randomized Controlled Trial

“…MBIs have also been found to improve stress, depressed mood, and sleep quality [ 55 - 57 ], which are all intertwined with chronic pain. Moreover, MBIs are emerging as promising approaches for mitigating heart disease and promoting cardiac rehabilitation [ 58 - 60 ]. Specifically, MBCT—which combines mindfulness strategies and cognitive therapy—is one of the most widely researched MBIs and may be uniquely suited for pain management given its potential effect on pain-related psychological factors such as catastrophic thinking and pain acceptance [ 21 , 61 - 65 ].…”