Abstract
Currently, exercise-based cardiac rehabilitation (CR) is the only recommended secondary prevention strategy for cardiac patients that attempts to tackle stress and psychosocial wellbeing, but it is under-utilized and lacks a comprehensive curriculum for this purpose; hence there is a critical gap to address psychosocial needs of cardiac patients after an event. Mindfulness-based stress reduction (MBSR) has shown benefits in the general population but its role in cardiac patients is not clear. We conducted a pilot randomized controlled trial (RCT) of MBSR in CR-eligible cardiac patients during their initial year of recovery. Patients were allocated 2:1 (intervention:control) to an 8-week MBSR group intervention or usual care. Standard measures of depression, anxiety, perceived stress, health related quality of life (HRQOL), blood pressure, biomarkers (lipids, HbA1c, CRP) and 24-hour Holter monitoring were obtained at baseline, 3- and 9-months post-randomization. Sub-group analyses were performed for participants with at least mild depression (PHQ-9 ≥ 5). 47 patients [mean age 58.6 years; 38% female; 77% white] were enrolled in 2 cohorts. 87% of MBSR patients completed the intervention; study retention was >95% at each follow-up visit. At 3 months, compared to controls, MBSR patients showed improvements in depression [p = 0.01] and anxiety [p = 0.04] with a similar trend in HRQOL [p = 0.06]. The MBSR group showed greater improvement or less worsening of most CV risk factors, with an attenuation of treatment effects at 9 months. Participants with at PHQ-9 scores ≥5 at baseline showed greater improvement in psychosocial and CV outcomes, that persisted at 9 months. MBSR is a safe and well received secondary prevention strategy. This pilot RCT provides preliminary evidence of MBSR’s potential to improve short term psychosocial well-being in cardiac patients during their first year of recovery.
Highlights
Up to 40% of cardiac patients experience significant levels of depression, anxiety, and stress following a myocardial infarction (MI) or other serious cardiac events or procedures[1,2,3,4]
One non-traditional treatment that is promising for cardiac patients but which has not been rigorously evaluated with this patient population is Mindfulness-Based Stress Reduction (MBSR)
MBSR potentially can enhance heart rate variability (HRV)[25,26], an important indicator of sympatho-vagal balance and flexible emotional regulation that typically is reduced in cardiac patients[27,28,29]
Summary
Up to 40% of cardiac patients experience significant levels of depression, anxiety, and stress following a myocardial infarction (MI) or other serious cardiac events or procedures[1,2,3,4] Such negative emotions contribute to poorer mental health and create challenges and barriers for patients in making and maintaining important behavioral and lifestyle modifications. One non-traditional treatment that is promising for cardiac patients but which has not been rigorously evaluated with this patient population is Mindfulness-Based Stress Reduction (MBSR). The primary goals of the study were to (1) establish feasibility of recruitment and retention strategies with this patient population, and (2) estimate treatment effects and variability of MBSR on levels of depression, anxiety, stress, health-related quality of life, and CV risk factors and biomarkers
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