Stress Management Could Cut Risk of Second Cardiac Events

In a new study, Duke Health researchers have found that integrating stress management into treatment regimens for patients who have suffered heart attacks or other heart-related issues could cut their risk of additional cardiac events in half.

The investigators conducted a randomized clinical trial involving 151 outpatients with coronary heart disease who were participating in cardiac rehabilitation as a result of heart blockages, chest pain, heart attacks, or bypass surgery. Patients participating in the trial ranged in age from 36 to 84 years old.
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Roughly half of the patients took part in 3 months of traditional cardiac rehabilitation, including exercise, a heart-healthy diet, and drugs intended to manage cholesterol and high blood pressure. The remaining group of patients underwent cardiac rehabilitation in addition to attending weekly, 90-minute stress management groups combining support, cognitive behavior therapy, muscle relaxation, and other stress-reduction techniques. The researchers followed patients for an average of 3 years after rehabilitation.

Among patients who only received cardiac rehabilitation, 33% suffered another cardiac event—such as heart attack, bypass surgery, stroke, hospitalization for chest pain, death from any cause. Meanwhile, just 18% of patients who took part in stress-management training as part of their cardiac rehabilitation experienced further cardiovascular issues. Both patient groups that took part in rehabilitation fared better than recovering heart patients who chose to forgo rehabilitation. Among the latter group, 47% later died or experienced another cardiovascular event.

Assessing the risk for untoward events in these vulnerable patients “extends beyond traditional risk factors such as high blood pressure and high cholesterol to include psychological factors,” says James Blumenthal, PhD, a clinical psychologist and professor of psychiatry and behavioral sciences at Duke, and lead author of the study.

Medical management is “only part of the optimal care” for these patients, he says, noting that comprehensive cardiac rehabilitation programs, which Blumenthal describes as “woefully underutilized,” should be strongly encouraged.

While lifestyle modification—smoking cessation, diet and exercise, for instance—is important, “helping patients cope more effectively with life stress provides additional benefits,” says Blumenthal. “Based on our findings, we hope that cardiac rehabilitation programs around the country will incorporate coping skills and stress management training routinely into their programs.”

—Mark McGraw

Reference:

Blumenthal J, Sherwood A, et al. Enhancing cardiac rehabilitation with stress management training: a randomized clinical efficacy trial [published online March 21, 2016]. Circulation. doi:10.1161/CIRCULATIONAHA.115.018926.