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Search our website. The potential benefits for the patient included improvements in mental health, physical health including mortality and quality of life; and for the partner improvements in mental health and quality of life. Significant clinical heterogeneity, however, was present with respect to patients' diagnoses, family members involved, interventions utilized, and how outcomes were measured. In addition, there was only minimal reporting of results for CHD patients and their partners. A recent systematic review of psychological interventions for patients with CHD [11] , which undertook meta-regression analyses, found that family interventions were less effective than non-family interventions; however this review only assessed patient outcomes.

Given the adverse impact of psychological distress and CHD it is important to reduce the prevalence and severity of depression and anxiety in patients with CHD. Psychological interventions appear effective in providing such benefit. Involving the partner in the intervention may provide additional benefit for both the patient and the partner, but to date no systematic review to examine this has been reported. The aim of this systematic review was to evaluate the effectiveness of psychological interventions for patients with CHD and their partners.

Randomized controlled trials with any length of follow-up, available as full trial report, were eligible for inclusion. There were no language restrictions. Trials which included adults, 18 years of age or older, with CHD were included.

Studies were excluded which only included participants with heart failure. To assess the effectiveness of psychological interventions, only trials which compared the intervention group to a control group receiving usual care were eligible. Psychological interventions were defined as all types of counselling, psycho-education, social support or therapy aimed at improving general well being for example mental health and quality of life. The intervention could include education as long as this was provided with a psychological component.

The intervention could be of any duration, any format group or individual and could be delivered by any health care workers for example nurses, psychologists, physicians or social workers. Studies which utilized an intervention which was education or relaxation only were excluded. Studies were excluded if the participant's support person only included co-workers. The following search strategy was used for Medline and was adapted for other databases:.

OR angina. OR counselling. OR significant other. AND randomized controlled trial. OR controlled clinical trial. OR randomi? OR placebo. OR clinical trials as topic. OR randomly. OR trial. Reference lists of eligible trials and relevant systematic reviews were searched for additional studies.

Studies were excluded based on titles and abstracts, and full text articles were retrieved and reviewed as necessary. Studies were assessed for inclusion in the review using a pre-designed eligibility form based on the inclusion criteria. If a trial did not contain sufficient information for a decision to be made about its eligibility, further information was sought from the trial's authors. The two authors independently determined which studies met the selection criteria.

Disagreements about study eligibility were resolved by discussion, or with consultation of a third reviewer. For each included trial, two authors independently extracted data using a pre-designed data extraction form. Data were extracted which described the characteristics of the trial country conducted, when conducted, setting, design, patients randomized and duration of follow-up ; the participants age, gender and diagnosis ; and the intervention significant other, personnel conducting the intervention, type of intervention, format and duration.

The comparator used in the study was also documented. Relevant outcomes were also extracted. If the reported data were incomplete or unclear, study authors were contacted. The reviewers worked independently, and disagreements were resolved through consensus, or in consultation with a third reviewer. Two of the review authors independently used The Cochrane Collaboration's tool for assessing risk of bias [15]. The gradings between reviewers were compared and any differences were resolved by discussion or in consultation with a third reviewer.

The treatment effect was analysed using relative risks RRs for dichotomous outcomes; and mean difference MD or standardized mean difference SMD for continuous data. Ninety-five percent confidence intervals CI were calculated for all analyses. All statistical analyses were undertaken using Review Manager Version 5. For trials with more than one intervention group, or more than one control group, all eligible intervention groups were combined and all eligible control groups were combined to create a single pair-wise comparison, using methods described in the Cochrane handbook [15].

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Groups were deemed eligible if they met the review's selection criteria. For trials which utilized a factorial design, data were combined from intervention groups of interest and control groups of interest regardless of other intervention s being evaluated. As stated in the criteria for considering studies section above , the other treatment s needed to apply to both intervention and comparison groups for the trial to be eligible. When more than one publication of an original trial was identified, the articles were assessed together to maximise data collection.

Outcomes were obtained from the longest follow-up period. Reviewers first assessed statistical heterogeneity by visual examination of the generated forest plots based on whether there was CI overlap and whether direction of treatment effect was consistent across studies. Although this review did not specifically exclude unpublished studies, it was possible that unpublished studies e.

Clinical Psychology and Heart Disease

The WHO International Clinical Trials Registry was searched to determine any evidence of the existence of reporting bias, such as if a trial was registered but not published. The random-effects meta-analysis was likely to be the most appropriate method to pool data together as some degree of clinical heterogeneity was expected.

When studies did not provide sufficient data for use in the meta-analysis, the results were reported separately. If it was deemed that the data were too statistically heterogeneous to combine statistically, a narrative synthesis was utilized. Sensitivity analyses were conducted for the outcomes of depression and anxiety, specifically analysis which only included studies with partners. An analysis was conducted to compare patient only psychological interventions with patient and partner psychological interventions.

The overall quality of the evidence was assessed using GRADE criteria risk of bias, consistency, imprecision, indirectness, and publication bias [17] , and was rated as high, moderate or low. Searches of the electronic databases resulted in records, of these were duplicates, resulting in references in total. Titles and abstracts were screened and 84 records were retrieved and reviewed in full text. Of these full text articles, seven studies 12 articles [18] — [29] fulfilled the inclusion criteria. The seven eligible studies resulted in dyads patient and partner randomized. A flowchart of the selection of studies for inclusion is presented in Figure 1.

All included studies were parallel group randomized controlled trials: four utilized simple randomization [18] , [21] , [23] , [24] and three randomized the treatment groups in blocks to prevent contamination [19] , [22] , [25].

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Two studies were conducted in the s [18] , [25] , two in the s [21] , [22] and three did not report when they were conducted [19] , [23] , [24]. Sample sizes ranged from 42 to patients randomized, mean age ranged from Three studies included patients post-MI [18] , [22] , [25] ; two post-MI with or without revascularization [19] , [24] ; and two post CABG [21] , [23]. Duration of follow-up ranged from two to 13 months Table 1. The psychological interventions comprised a range of components, format, personnel involved, frequency, number of sessions and duration Table 2.

Studies reported on a variety of outcomes Table 3 and used a number of different questionnaires. Reporting of methodology used in the included studies was generally poor.

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Table 4 shows the results of the risk of bias assessment. Unpublished data were obtained from the authors of four studies [18] , [22] , [24] , [25]. Six studies evaluated this outcome [18] , [19] , [22] — [25]. Data were able to be combined from four of these [18] , [19] , [22] , [25]. Of the studies which did not report data suitable for meta-analysis, one reported that the usual care group had lower levels of depressive symptoms at follow-up but these differences were non-significant [23] , the other reported that the intervention group showed more favourable changes in depressive symptoms than the usual care group [24].

Examining the forest plot Figure 2 indicated that one study [18] had a different effect size than the others. This study included family members and co-workers and was therefore fundamentally different to the other three studies which only included partners. Five studies evaluated this [18] , [19] , [21] , [22] , [25].

Data were able to be combined from four of them [18] , [19] , [22] , [25].

Psychocardiology and the Role of the Psychologist in Acquired and Congenital Heart Disease

The study which did not report suitable data for meta-analysis found no significant effects for group [21]. Three studies evaluated this [22] — [24]. Two studies used tools to measure functional status [22] , [23] and one study used a tool to measure overall health [24] Table 5 at follow-up times of six to 13 months. Three studies evaluated this [18] , [22] , [25] at six to 13 months follow-up. There was no significant difference found between the two groups in all-cause mortality RR 1. Two studies reported smoking, blood pressure, physical activity and weight at six months follow-up [19] , [25].