Cognitive behavioral therapy improves outcomes in CHD

Cognitive behavioral therapy (CBT) reduces the risk of repeat cardiac events in patients with coronary heart disease, a new trial found.

The Swedish study randomized 362 patients who had been hospitalized for a coronary heart disease event to usual care or usual care plus group CBT focused on stress. The CBT group met for 20 two-hour sessions during a year, after which the patients were followed for a mean of 94 months. Attendance at the CBT session varied, with a median rate of 85%. The study appears in the Jan. 24 Archives of Internal Medicine.

After adjustment for variables including traditional risk factors, patients in the CBT group were 41% less likely to have a recurrent cardiovascular disease event (hazard ratio, 0.59; 95% CI, 0.42 to 0.83; P=0.002) and 45% less likely to have a recurrent acute myocardial infarction (HR, 0.55; 95% CI, 0.36 to 0.85; P=0.007) than those receiving usual care. The therapy group also had a 28% lower risk of all-cause mortality, although this difference was not statistically significant.

There was also a strong dose-response effect between therapy group attendance and cardiovascular events. The proportion of patients having a first recurrent event increased almost linearly, from 53% among patients who attended all sessions to 73% in patients who attended marginally. Benefits of the therapy were similar in men and women. The number of patients needed to treat was 9 for any cardiovascular event and 10 for myocardial infarction.

The study authors concluded that CBT could be an effective addition to secondary preventive programs after myocardial infarction. One possible mechanism for the effect is decreased behavioral and emotional reactivity, leading to less psychophysiologic burden on the cardiovascular system, the authors speculated. Based on the findings of this and other studies, they suggested that interventions be at least 6 to 12 months long, be conducted in groups, and include specific techniques for altering behavior.