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- Burell, Gunilla, et al.
(författare)
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Affective Outcomes in the SUPRIM Stress Management Program for Post-Myocardial Infarction Patients
- 2014
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Konferensbidrag (refereegranskat)abstract
- BackgroundThe Interheart Study showed that psychosocial stress increased the risk of myocardial infarction (OR 2.67). The Secondary Prevention in Uppsala Primary healthcare project (SUPRIM) tested whether stress management after myocardial infarction could decrease risk of recurrent cardiovascular events. SUPRIM was a randomized controlled trial in which CHD patients attended a CBT group stress management program. During 94 months of follow-up there was a 45% reduction of recurrent myocardial infarctions (MI) in the intervention group. There were no differences between intervention and control patientes in standard risk factors. Thus, we assumed that psychological mechanisms could explain the effects on hard endpoints.Method362 MI patients were assessed by a package of self-rating psychometric instrument, and this paper examined whether hostility, time urgency, depression, somatic anxiety, and vital exhaustion decreased more in the intervention group than in the control group. Data collected from 5 points of measurement over 24 months were analyzed with multi-linear regression.ResultsThe intervention had a significant effect on hostility, time urgency, and somatic anxiety. Vital exhaustion and depression scores showed no differences. There was a significant relationship between attendance rate and decrease of hostility, but no association between attendance rate and levels of vital exhaustion or depression.ConclusionsTreatment effects were demonstrated in measures that assessed emotional reactivity. These changes are possibly linked to physiological and hormonal mechanisms. However, it is to a considerable degree still unknown why and how the stress management intervention impacts disease endpoints.
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| 3. |
- Gulliksson, Mats, et al.
(författare)
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Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart Disease Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM)
- 2011
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Ingår i: Archives of Internal Medicine. - : American Medical Association (AMA). - 0003-9926 .- 1538-3679. ; 171:2, s. 134-140
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Tidskriftsartikel (refereegranskat)abstract
- Background: Psychosocial factors are independently associated with increased risk of cardiovascular disease(CVD) morbidity and mortality, but the effects of psychosocial factor intervention on CVD are uncertain. We performed a randomized controlled clinical trial of cognitive behavioral therapy (CBT) to measure its effects on CVD recurrence. Methods: The study included 362 women and men 75 years or younger who were discharged from the hospital after a coronary heart disease event within the past 12 months. Patients were randomized to receive traditional care (reference group, 170 patients) or traditional care plus a CBT program (intervention group, 192 patients), focused on stress management, with 20 two-hour sessions during 1 year. Median attendance at each CBT session was 85%. Outcome variables were all-cause mortality, hospital admission for recurrent CVD, and recurrent acute myocardial infarction. Results: During a mean 94 months of follow-up, the intervention group had a 41% lower rate of fatal and non-fatal first recurrent CVD events (hazard ratio [95% confidence interval], 0.59 [0.42-0.83]; P=.002), 45% fewer recurrent acute myocardial infarctions (0.55 [0.36-0.85]; P=.007), and a nonsignificant 28% lower all-cause mortality (0.72 [0.40-1.30]; P=.28) than the reference group after adjustment for other outcome-affecting variables. In the CBT group there was a strong dose-response effect between intervention group attendance and outcome. During the first 2 years of follow-up, there were no significant group differences in traditional risk factors. Conclusions: A CBT intervention program decreases the risk of recurrent CVD and recurrent acute myocardial infarction. This may have implications for secondary preventive programs in patients with coronary heart disease.
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