BACKGROUND: Psychological interventions can form part of comprehensive cardiac rehabilitation programmes (CCR). These interventions may include stress management interventions, which aim to reduce stress, either as an end in itself or to reduce risk for further cardiac events in patients with heart disease. OBJECTIVES: To determine the effectiveness of psychological interventions, in particular stress management interventions, on mortality and morbidity, psychological measures, quality of life, and modifiable cardiac risk factors, in patients with coronary heart disease (CHD). SEARCH STRATEGY: We searched CCTR to December 2001 (Issue 4, 2001), MEDLINE 1999 to December 2001 and EMBASE 1998 to the end of 2001, PsychINFO and CINAHL to December 2001. In addition, searches of reference lists of papers were made and expert advice was sought. SELECTION CRITERIA: RCTs of non-pharmacological psychological interventions, administered by trained staff, either single modality interventions or a part of CCR with minimum follow up of 6 months. Adults of all ages with CHD (prior myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, angina pectoris or coronary artery disease defined by angiography). Stress management (SM) trials were identified and reported in combination with other psychological interventions and separately. DATA COLLECTION AND ANALYSIS: Studies were selected, and data were abstracted, independently by two reviewers. Authors were contacted where possible to obtain missing information. MAIN RESULTS: Thirty six trials with 12,841 patients were included. Of these, 18 (5242 patients) were SM trials. Quality of many trials was poor with the majority not reporting adequate concealment of allocation, and only 6 blinded outcome assessors. Combining the results of all trials showed no strong evidence of effect on total or cardiac mortality, or revascularisation. There was a reduction in the number of non-fatal reinfarctions in the intervention group (OR 0.78 (0.67, 0.90), but the two largest trials (with 4809 patients randomized) were null for this outcome, and there was statistical evidence of publication bias. Similar results were seen for the SM subgroup of trials. Provision of any psychological intervention or SM intervention caused small reductions in anxiety and depression. Few trials reported modifiable cardiac risk factors or quality of life. REVIEWERS' CONCLUSIONS: Overall psychological interventions showed no evidence of effect on total or cardiac mortality, but did show small reductions in anxiety and depression in patients with CHD. Similar results were seen for SM interventions when considered separately. However, the poor quality of trials, considerable heterogeneity observed between trials and evidence of significant publication bias make the pooled finding of a reduction in non-fatal myocardial infarction insecure.

/pdf/psychological-interventions-for-coronary-heart-disease-117rfwzkjw.pdf

Psychological interventions for coronary heart disease

Background: Psychological symptoms are strongly associated with coronary heart disease (CHD), and many psychological treatments are offered following cardiac events or procedures.


Objectives: Update the existing Cochrane review to (1) determine the independent effects of psychological interventions in patients with CHD (principal outcome measures included total or cardiac‐related mortality, cardiac morbidity, depression, and anxiety) and (2) explore study‐level predictors of the impact of these interventions.


Search methods: The original review searched Cochrane Controleed Trials Register (CCTR, Issue 4, 2001), MEDLINE, EMBASE, PsycINFO, and CINAHL to December 2001. This was updated by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, PsycINFO and CINAHL from 2001 to January 2009. In addition, we searched reference lists of papers, and expert advice was sought for the original and update review.


Selection criteria: Randomised controlled trials of psychological interventions compared to usual care, administered by trained staff. Only studies estimating the independent effect of the psychological component with a minimum follow‐up of six months. Adults with specific diagnosis of CHD.


Data collection and analysis: Titles and abstracts of all references screened for eligibility by two reviewers independently; data extracted by the lead author and checked by a second reviewer. Authors contacted where possible to obtain missing information.


Main results: There was no strong evidence that psychological intervention reduced total deaths, risk of revascularisation, or non‐fatal infarction. Amongst a smaller group of studies reporting cardiac mortality there was a modest positive effect of psychological intervention (relative risk: 0.80 (95% CI 0.64 to 1.00)). Furthermore, psychological intervention did result in small/moderate improvements in depression, standardised mean difference (SMD): ‐0.21 (95% CI ‐0.35, ‐0.08) and anxiety, SMD: –0.25 (95% CI ‐0.48 to –0.03). Results for mortality indicated some evidence of small‐study bias, though results for other outcomes did not. Meta regression analyses revealed four significant predictors of intervention effects on depression were found: (1) an aim to treat type‐A behaviours (s = ‐0.32, p = 0.03) were more effective than other interventions. In contrast, interventions which (2) aimed to educate patients about cardiac risk factors (s = 0.23, p = 0.03), (3) included client‐led discussion and emotional support as core therapeutic components (s = 0.31, p < 0.01), or (4) included family members in the treatment process (s = 0.26, p < 0.01) were significantly less effective.


Authors' conclusions: Psychological treatments appear effective in treating psychological symptoms of CHD patients. Uncertainly remains regarding the subgroups of patients who would benefit most from treatment and the characteristics of successful interventions.

https://medicine.exeter.ac.uk/media/universityofexeter/medicalschool/research/pentag/documents/Psych_interventions_for_CHD.pdf

Psychological interventions for coronary heart disease (Review)

Objective This review evaluates the effectiveness of quality improvement (QI) strategies in reducing disparities in health and health care. Data sources We identified papers published in English between 1983 and 2011 from the MEDLINE® database, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science Social Science Index, and PsycINFO. Review methods All abstracts and full-text articles were dually reviewed. Studies were eligible if they reported data on effectiveness of QI interventions on processes or health outcomes in the United States such that the impact on a health disparity could be measured. The review focused on the following clinical conditions: breast cancer, colorectal cancer, diabetes, heart failure, hypertension, coronary artery disease, asthma, major depressive disorder, cystic fibrosis, pneumonia, pregnancy, and end-stage renal disease. It assessed health disparities associated with race or ethnicity, socioeconomic status, insurance status, sexual orientation, health literacy/numeracy, and language barrier. We evaluated the risk of bias of individual studies and the overall strength of the body of evidence based on risk of bias, consistency, directness, and precision. Results Nineteen papers, representing 14 primary research studies, met criteria for inclusion. All but one of the studies incorporated multiple components into their QI approach. Patient education was part of most interventions (12 of 14), although the specific approach differed substantially across the studies. Ten of the studies incorporated self-management; this would include, for example, teaching individuals with diabetes to check their blood sugar regularly. Most (8 of 14) included some sort of provider education, which may have focused on the clinical issue or on raising awareness about disparities affecting the target population. Studies evaluated the effect of these strategies on disparities in the prevention or treatment of breast or colorectal cancer, cardiovascular disease, depression, or diabetes. Overall, QI interventions were not shown to reduce disparities. Most studies have focused on racial or ethnic disparities, with some targeted interventions demonstrating greater effect in racial minorities--specifically, supporting individuals in tracking their blood pressure at home to reduce blood pressure and collaborative care to improve depression care. In one study, the effect of a language-concordant breast cancer screening intervention was helpful in promoting mammography in Spanish-speaking women. For some depression care outcomes, the collaborative care model was more effective in less-educated individuals than in those with more education and in women than in men. Conclusions The literature on QI interventions generally and their ability to improve health and health care is large. Whether those interventions are effective at reducing disparities remains unclear. This report should not be construed to assess the general effectiveness of QI in the health care setting; rather, QI has not been shown specifically to reduce known disparities in health care or health outcomes. In a few instances, some increased effect is seen in disadvantaged populations; these studies should be replicated and the interventions studied further as having potential to address disparities.

Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).

Previous reports of the effectiveness of psychological treatments (PTs) for cardiac patients reveal inconsistent results. We determined overall effects and gender differences. Eligible studies were randomized controlled trials, containing a PT arm. The authors identified 43 relevant randomized trials; 23 reported mortality data for 9856 patients. The odds-ratio (OR) for all-cause mortality at follow-up of 2 years or less, comparing PT plus usual care vs. usual care only, was OR 0.72 [95% confidence interval (CI) 0.56-0.94], but weakened with longer follow-up (OR 0.89; 95% CI 0.80-1.10). Mortality benefits only applied to men (OR 0.73, 95% CI 0.57-1.00; OR 1.01; 95% CI 0.87-1.72 for women). Trials initiating treatment at least 2 months after a cardiac event showed greater mortality benefits than those initiating treatment right after the event (OR 0.28; 95% CI 0.11-0.70 vs. OR 0.87; 95% CI 0.86-1.15, respectively). Mortality benefits due to PT were achieved despite small concomitant changes in negative affect. PT of cardiac patients reduces mortality and event recurrence. The mortality benefits appeared only in men even after controlling for age differences. The timing for the initiation of PT may be a critical mediating variable for mortality outcomes.

/pdf/psychological-treatment-of-cardiac-patients-a-meta-analysis-1pkklwul5l.pdf

Psychological treatment of cardiac patients: a meta-analysis

We performed a comprehensive review of the literature to determine whether or not a relationship between depression and coronary artery disease exists. Our literature search supports the following: Depression and coronary artery disease have a bidirectional relationship, i.e., coronary artery disease can cause depression and depression is an independent risk factor for coronary artery disease and its complications; depression may contribute to sudden cardiac death and increase all causes of cardiac mortality; and depression contributes to unhealthy lifestyle and poor adherence to treatment. We review various pathophysiological links between depression and coronary artery disease and screening for depression in at-risk patients for coronary artery disease. We also discuss pharmacological treatments, their implications, and various behavioral treatments.

Depression and coronary artery disease: the association, mechanisms, and therapeutic implications.

The purpose of this study is to determine the effectiveness of a group cognitive-behavioral treatment to modify coronary-prone behaviors in patients from a fairly low social and educational level. Participants were 98 male coronary patients randomly allocated to one experimental and two control groups. All groups received standard medical treatment. The experimental group received an additional psychological treatment and one of the two control groups received a health education treatment. Results showed that only the psychological treatment group significantly reduced Pressured Drive and Speed-Impatience after treatment, and at 1- and 2-year follow-ups. Depression was also significantly reduced only in this group at 2-year follow-up. The results are considered a reliable first step in the process of validating this program designed to improve coronary heart disease patients' quality of life.

/pdf/modification-of-coronary-prone-behaviors-in-coronary-3t61djmgxt.pdf

Modification of coronary-prone behaviors in coronary patients of low socio-economic status.

Este estudio, realizado sobre 98 varones enfermos de corazon de nivel socioeconomico bajo, valora la efectividad de un tratamiento cognitivo-conductual desarrollado en grupo. Los participantes fueron asignados al azar a un tratamiento psicologico, a un tratamiento de educacion para la salud o recibieron solo el tratamiento medico estandar para pacientes coronarios. Despues de un ano de tratamiento y tras dos anos de seguimiento, solo en el grupo que recibio tratamiento psicologico se produjeron diferencias estadisticamente significativas en PCTA, especialmente en el factor «Prisa-Impaciencia», valorado por la Entrevista Estructurada, y en Ansiedad Rasgo. Estos resultados son considerados un primer paso fiable en el proceso de validar este tratamiento. Effectiveness of a cognitive-behavioural program to modify coronary-prone behaviours. This randomised trial presents the effectiveness of a cognitive-behavioural group treatment to modify coronaryprone behaviours of patients of low socio-economic status. Probands in this study were 98 males assigned to a psychological treatment, to a health education treatment, or to a standard medical treatment for coronary patients. After the year of treatment and after two years of follow-up, only in the psychological treatment group were there statistically significant differences in the TABP, especially in the ‘Speed-Impatience’ factor, measured by Structured Interview, and in Trait Anxiety. These results are considered a reliable first step in the process of validating this treatment.

https://cmvinalo.webs.ull.es/docencia/Posgrado/3-ENFERMEDADES-CARDIOVASCULARES/tratamiento%20pronocoronario.pdf

Eficacia de un programa cognitivo-conductual para modificar conductas prono-coronarias

Este trabajo presenta la efectividad de un tratamiento cognitivo-conductual aplicado en grupo. Participaron 98 varones afectos de enfermedad coronaria. Fueron asignados al azar a un tratamiento psicologico (TPs), a un programa de educacion para la salud (PES) o a solo el tratamiento medico estandar (TME) para pacientes coronarios. Despues del ano de tratamiento, solo en el grupo con TPs se dieron diferencias estadisticamente significativas en Patron de Conducta Tipo A (PCTA) medido por la Entrevista Estructurada (EE), y en ansiedad rasgo. Tras dos anos de seguimiento, el grupo con TPs mostro una reduccion estadisticamente significativa en PCTA, especialmente "Rapidez Impaciencia", y en depresion. Los resultados PCTA se valoran como un primer paso fiable en el proceso de validar este tratamiento que, ademas, ha conseguido reducir de forma significativa la ansiedad y depresion, un resultado no frecuente en los tratamientos psicoeducativos aplicados a pacientes coronarios.

/pdf/modificacion-de-conductas-prono-coronarias-en-pacientes-de-teerhoqg9r.pdf

Modificación de conductas prono-coronarias en pacientes de estatus socio-económico bajo

Histamine intolerance occurs when there is an imbalance between histamine production and the capacity for histamine degradation. Diamine oxidase (DAO) is the main enzyme for the catabolism of ingested histamine degradation in the gastrointestinal tract and its deficiency has been linked to allergy-like symptoms. Psychostimulant drugs are commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD), but their interaction with DAO is not well characterized. In this work, we evaluated the effects of psychostimulant drugs (methylphenidate and lisdexamfetamine) on in vitro DAO activity and in the human cell line of enterocytes (Caco-2), evaluating DAO expression (mRNA and protein) and DAO activity. Methylphenidate and lisdexamfetamine did not repress the in vitro DAO activity. In addition, in Caco-2 cells, lisdexamfetamine promoted a strong upregulation of DAO mRNA levels, whereas methylphenidate tended to induce DAO activity. To sum up, methylphenidate and lisdexamfetamine treatments do not reduce DAO activity. These findings could be useful for physicians prescribing these two drugs to ADHD patients affected by DAO deficiency.

Interaction of Diamino Oxidase with Psychostimulant Drugs for ADHD Management

Background The pathological mechanisms of SARS-CoV-2 in humans remain unclear and the unpredictability of COVID-19 progression may be attributed to the absence of biomarkers that contribute to the prognosis of this disease. Therefore, the discovery of biomarkers is needed for reliable risk stratification and to identify patients who are more likely to progress to a critical stage. Methods Aiming to identify new biomarkers we analysed N-glycan traits in plasma from 196 patients with COVID-19. Samples were classified into three groups according to their severity (mild, severe and critical) and obtained at diagnosis (baseline) and at 4 weeks of follow-up (postdiagnosis), to evaluate their behaviour through disease progression. N-glycans were released with PNGase F and labelled with Rapifluor-MS, followed by their analysis by LC-MS/MS. The Simglycan structural identification tool and Glycostore database were employed to predict the structure of glycans. Results We determined that plasma from SARS-CoV-2-infected patients display different N-glycosylation profiles depending on the disease severity. Specifically, levels of fucosylation and galactosylation decreased with increasing severity and Fuc1Hex5HexNAc5 was identified as the most suitable biomarker to stratify patients at diagnosis and distinguish mild from critical outcomes. Conclusion In this study we explored the global plasma glycosignature, reflecting the inflammatory state of the organs during the infectious disease. Our findings show the promising potential of glycans as biomarkers of COVID-19 severity.

/pdf/fucosylated-n-glycans-as-early-biomarkers-of-covid-19-2wsdmkg8.pdf

Antonio del Pino

Papers

Modification of coronary-prone behaviors in coronary patients of low socio-economic status.

Eficacia de un programa cognitivo-conductual para modificar conductas prono-coronarias

Modificación de conductas prono-coronarias en pacientes de estatus socio-económico bajo

Interaction of Diamino Oxidase with Psychostimulant Drugs for ADHD Management

Fucosylated N-glycans as early biomarkers of COVID-19 severity