A systematic review and meta-analysis of mindfulness-based interventions for patients with coronary heart disease.

Abstract

To assess the effects of mindfulness-based interventions for patients with coronary heart disease. A systematic review with meta-analysis. Eight mainstream databases, including Ovid MEDLINE, Embase, Ovid Emcare, PsycInfo, CINAHL complete, Web of Science, CENTRAL and PubMed, were searched from January 1979-March 2020. Randomized controlled trials that evaluated mindfulness-based interventions on psychological outcomes, cardiovascular risk factors and quality of life in adults with coronary heart disease were considered. We conducted meta-analyses using the random-effects model. Nine studies involving 644 participants were included. Compared with inactive controls (e.g. usual care), mindfulness-based interventions significantly reduced depression (SMD -0.72, 95% CI -1.23 to -0.21, p<.01) and stress (SMD -0.67, 95% CI -1.00 to -0.34, p<.01), but not anxiety and blood pressure. There were no significant psychological effects compared with active controls (e.g. other psychological interventions). In one of three studies that assessed generic quality of life, mindfulness-based interventions significantly improved psychological and social domains compared with active control. The intervention effects on other cardiovascular risk factors were inconclusive given that only one study assessed each outcome with non-significant findings. Subgroup analyses suggest that intervention type and participants' depression and anxiety status may influence intervention effects. Mindfulness-based interventions may benefit patients with coronary heart disease in reducing depression and stress, but the effects on cardiovascular risk factors and quality of life are inconclusive. This review offers preliminary evidence for the potential of mindfulness-based interventions as an effective complementary approach to addressing psychological distress among people with coronary heart disease. Given the limitations in current studies, further rigorously designed and well-reported research is necessary to give robust evidence. Studies exploring the intervention effects on cardiovascular risk factors and quality of life are warranted to remedy the research and knowledge gap.