Michael E. Thase, MD
In patients recently hospitalized with a cardiovascular (CV) disease event, does cognitive-behavioral therapy (CBT) reduce risk for recurrence?
Randomized controlled trial. ClinicalTrials.gov NCT00888485.
Mean 94 months.
362 patients ≤ 75 years of age (mean age 62 y, 77% men) who were hospitalized for a CV disease event (acute myocardial infarction [MI], percutaneous coronary intervention, or coronary artery bypass graft) and referred back to primary care ≥ 3 months after discharge and ≤ 1 year after admission.
CBT, given in twenty 2-hour, single-sex group sessions over 1 year, plus usual care targeting traditional CV risk factors (n = 192), or usual care alone (n = 170). CBT had 5 components that focused on stress management: education, self-monitoring, skills training, cognitive restructuring, and spiritual development.
Fatal or nonfatal recurrent CV disease events, fatal or nonfatal acute MI, and all-cause mortality.
100% for death and hospitalization using national registries (intention-to-treat analysis).
Adding CBT to usual care reduced risk for recurrent CV events and acute MI (Table); groups did not differ for all-cause mortality (Table).
Adding cognitive-behavioral therapy to usual care reduced risk for recurrent events in patients recently hospitalized with cardiovascular disease events.
Cognitive-behavioral therapy (CBT) plus usual care (UC) vs UC alone in patients with cardiovascular (CV) disease†
†MI = myocardial infarction; other abbreviations defined in Glossary. RRR and CI calculated from adjusted hazard ratios and control event rates in article. NNT and CI provided by author and rounded up.
‡Adjusted for age, sex, marital status, education, smoking habits, medical history or comorbid conditions, and the following at ≤ 2 y: mean systolic blood pressure; serum cholesterol level; serum triglyceride level; and scores for vital exhaustion, coping, and credence in the future.
§Authors confirmed that new MI events after baseline included first and recurrent events.
Thase ME. Cognitive-behavioral therapy reduced risk for recurrence in patients recently hospitalized with cardiovascular disease events. Ann Intern Med. ;154:JC5–4. doi: 10.7326/0003-4819-154-10-201105170-02004
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Published: Ann Intern Med. 2011;154(10):JC5-4.
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