1. META-ANALYSIS OF THE EFFECTIVENESS OF PSYCHOLOGICAL SUPPORT ON THE IMPROVEMENT OF CORONARY HEART DISEASE PATIENTS’ OUTCOMES Aggelopoulou Z 1,, Mantzorou M. 2, Mastrogiannis D. 3,Spirou A. 4, Giannisi M. 5, Demenopoulou S. 5, Dr Brokalaki H. 6 1. Kapodistrian University of Athens, 2. TEI of Athens, 3.TEI of Lamia, 4. Onnassio Cardiosurgical Center, 5. NIMTS Veterans Hospital, 6. Nursing Faculty, Kapodistrian University of Athens META-ANALYSIS OF THE EFFECTIVENESS OF PSYCHOLOGICAL SUPPORT ON THE IMPROVEMENT OF CORONARY HEART DISEASE PATIENTS’ OUTCOMES Aggelopoulou Z 1,, Mantzorou M. 2, Mastrogiannis D. 3,Spirou A. 4, Giannisi M. 5, Demenopoulou S. 5, Dr Brokalaki H. 6 1. Kapodistrian University of Athens, 2. TEI of Athens, 3.TEI of Lamia, 4. Onnassio Cardiosurgical Center, 5. NIMTS Veterans Hospital, 6. Nursing Faculty, Kapodistrian University of Athens Background: Accumulating evidence from epidemiological studies supports that psychological factors related to patterns of behaviour and lifestyle may exacerbate the pathophysiologic mechanisms responsible for the onset and development of Coronary heart disease (CHD). These include depression, social isolation, low socioeconomic status and chronic stress such as occupational or marital distress, and lay caregiver stress. Objective: The aim of this study was to explore whether psychological interventions account for improvements in patients’ outcomes when combined with conventional therapeutic rehabilitation programmes for patients with coronary heart disease.. Conclusions: It is essential that psychological interventions are incorporated into the rehabilitation of patients with coronary heart disease (CHD). More clinical trials are needed to clarify the effect of psychological interventions for these patients. Materials: Each study should have included patients with diagnosed coronary disease one or more methods of control for the development of disease team of intervention in which were offered the psycho society support and/or program of exercise (with the exception of the medication of antidepressant, apart from the usual treatment) measurement of cardiac incidents and mortality after follow-up of at least 6 months and methodology randomize clinical trial Results: Data on mortality and heart episodes were available in 9 out of the 39 studies located. Methods: A meta-analysis of 9 randomized controlled trials, which evaluated the additional impact of a psychological intervention introduced in the regular treatment of patients with coronary heart disease was carried out through the STATA 8.0. Outcome variables included mortality and new heart episodes. Author, Year of Publication Ref.Study Design N (control group/ intervention) PatientsInterventionMeasurementsResults Krucoff et al, 2005 1 The LancetRCT371 patients were assigned prayer and 377 no prayer; 374 were assigned MIT therapy and 374 no MIT therapy. PCLTwo practices: intercessory prayer and music, imagery, and touch (MIT) therapy. 6 month- cardiovascular events and readmission or death No significant difference was found for the primary composite endpoint in any treatment comparison. Mortality at 6 months was lower with MIT therapy than with no MIT therapy Van Dixhoorn et al, 1987 2 European Heart Journal RCT42/46MIExercise training and relaxation therapy - breathing therapy (A)/ exercise training only(B) Cardiac events, consisting of cardiac death and of readmission to hospital Cardiac event were lower in group A Van Dixhoorn et al, 1999 3 Journal of cardiopulmonary rehabilitation RCT76/80MIExercise plus relaxation and breathing therapy / to exercise training only. Major cardiac events and cardiac rehospitalisation Approximately 50% decrease in cardiac events. 31% decrease in total number of hospitalizations, as a result of relaxation instruction. Brandi et al, 2004 4 Journal of the American college of cardiology RCT812/1000POST-MIExercise and education sessions for 6.6±4.6 years Recurrent MI and death Improvement in survival and reduction in the risk of recurrent MI Jones et al, 1996 5 BMJ JournalRCT2328MIRehabilitation programmes comprising psychological therapy, counselling, relaxation training, and stress management training Anxiety, depression, quality of life, morbidity, use of medication, and mortality. At six months there were no significant differences between rehabilitation patients and controls in reported anxiety or depression.. At 12 months there were no differences in clinical complications, clinical sequelae, or mortality. Ornish et al, 1998 6 JAMARCT20/28CHDExercise, diet, stress management, social support Diameter of coronary stenosis AND cardiac events 5-year follow-up Decrease in coronary stenosis and in the risk for new cardiac events in intervention group Frasure-Smith et al, 1985 7 Phychosomatic Medicine RCT224/229CHDStress monitoring in which nurses provided non- specific psychosocial support (patients were conducted on a monthly basis) Anxiety, stress and mortality 50% decrease in mortality rate at 1 year,33% decrease in mortality rate at 5 years.Treatment effective for reduction of anxiety & stress Denollet et al, 2001 8 Non-RCT72/78CHDExercise sessions and psychosocial sessions MortalityLower Mortality rate Carney et al,: 2ary analysis of ENRICHD,2004 9 Multicent er RCT from 1996 to 2000 409/449CHDGroup cognitive behaviour therapy for up to 6 months Administration of sertraline for up to I year for patients with severe depression MortalityGreater risk for late mortality among patients who did not respond to treatment. Funnel plot and ordeal Egger' s for the publication bias (time of follow-up from 0,5 until 9 years) bias coefficient=-1.58, SE=1.44, p=0.310 Pooled Relative Risk for death/cardiac episodes (time of follow-up from 0,5 until 9 years) pooled estimate = 0,58 (95% ΔΕ:0,41-0,83, p=0.003) Funnel plot and ordeal Egger' s for the publication bias (time of follow-up ≤ 2 years) bias coefficient= 2,14, SE=1.87, p=0.092 Relative Risk of studies and Pooled Estimate (time of follow-up from ≤ 2 years) pooled estimate = 0,77 (95% ΔΕ:0,55-1,09, p=0.145) Funnel plot and ordeal Egger' s for the publication bias (time of follow-up from > 2 years) bias coefficient=-0,21, SE=0,57, p=0.749 Relative Risk and Pooled Estimate (time of follow-up from > 2 years) pooled estimate = 0,45 (95% ΔΕ:0,37-0,54, p<0,001) References : 1.Krucoff MW, Crater SW, Gallup D, Blankenship JC, Cuffe M, Guarneri M. Krieger R, Kshettry V, Morris K, Oz M. Music, imagery, touch, and prayer as adjuncts to interventional cardiac care: The monitoring and actualization of notice trainings (MANTRA) II randomized study. Lancet 366:211-217. 2.Van Dixhoorn J, Duivenvoorden HJ, Staal HA, Pool J, Verhage F. Cardiac events after myocardial infarction: possible effects of relaxation therapy. Eur Heart J. 1987;3:1210-1214. 3.Van Dixhoorn J, Duivenvoorden HJ, Pool J, Verhage F. Psychic effects of physical training and relaxation therapy after myocardial infarction. J Psychosom Res. 1999;34:327-337. 4.Brandi JW, Steven JJ, Susan AW, Jill MK,Ryan AM, Thomas GA, Guy SR, Roger VL, Cardiac Rehabilitation After Myocardial Infarction in the Community Journal of the American College of Cardiology 2004, 44, ( 5):988-996 5.Jones DA, West RR. Psychological rehabilitation after myocardial infarc­tion: multicenter randomized controlled trial. BAU 1996;313:1517-1521. 6.Ornish D. Swherwitz L. Billings J. Gould L. Merritt T. Sparler S. Armstrong W. Ports T. 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