Mindfulness-based interventions help reduce perceived stress, depression, anxiety in CHD patients

Mindfulness-based interventions (MBIs) are beneficial for patients with coronary heart disease (CHD) in reducing perceived stress, depression and anxiety, as shown by evidence in a systematic review, which was presented at the recent European Society of Cardiology (ESC) Asia Congress 2019 in Singapore.

Seven English and two Chinese electronic databases were searched from inception to January 2019 for randomized controlled trials (RCTs) that evaluated the effects of MBIs on stress, depression and anxiety in adults with CHD. Two reviewers independently screened records for eligibility and extracted data. Risk of bias was assessed using the Cochrane tool.

Six RCTs involving 472 participants met the eligibility criteria. Of these, five compared MBIs with inactive controls (ie, usual care and waitlist control), while the remaining study utilized a self-help group that received a booklet containing identical mindfulness information as an active control.

High risks of bias were found across studies, particularly in performance and detection biases.

Compared with inactive controls, those who underwent MBIs had significant decrease in perceived stress, depression and anxiety. On the other hand, MBIs had a nonsignificant effect on perceived stress and significant reductions in depression and anxiety when compared with active controls. [ESC Asia 2019, abstract P191].

“These findings need to be interpreted with caution given the small sample sizes and methodological limitations within included studies,” the researchers said.

“Rigorous-designed research is urgently needed to further confirm the effectiveness of MBIs on improving psychological health in patients with CHD,” they added.

One of the included studies examined the effect of the Mindfulness-Based Stress Reduction (MBSR) programme on 30 male patients with CHD in India. Results showed that the MBSR programme was effective in reducing symptoms of anxiety and depression, perceived stress, blood pressure and body mass index in these patients. [Int J Yoga 2013;6:111-117]

Findings of the current review were also supported by a recent study investigating the effectiveness of the MBSR programme, which reported improvements in self-efficacy and quality of life (QoL) in patients with cardiovascular disease.

On post-test and 3-month follow-up, mean scores of self-efficacy (60.80±5.91 and 60.40±7.03) and QoL (103.80±9.35 and 101.10±9.13) were higher among those who underwent the intervention than controls. [Int J Cardiol Heart Vasc 2019;doi:10.1016/j.ijcha.2019.100356]

Moreover, a recent systematic review focusing on the use of MBIs in older adults provided evidence that such an intervention effectively reduced depression in this cohort. However, no clear evidence was found in terms of reducing perceived stress and anxiety or the positive effects of MBIs in the long term. [Int J Ment Health Nurs 2019;28:635-656]

“Psychological stress and distress (eg, depression and anxiety) are prevalent for people with CHD, imposing a great challenge for the secondary prevention of CHD,” the researchers said. “MBIs, which incorporate mindfulness skills and cognitive strategies, are suggested as a promising approach to help patients with CHD to improve their psychological health.”