Taming the anxious heart: do cognitive-behavioural therapy -based interventions reduce cardiac anxiety in patients with heart failure and chronic cardiac disease?
R Olszewski, J Brzezinski, K Watros, M Manczak, J Owoc, K JeziorskiAbstract
Background
Heart failure (HF) and other chronic cardiac diseases (CCD) associated with cardiac anxiety (CA) are characterized by a significant reduction in quality of life. Patients with these conditions often experience adverse clinical outcomes, including poorer treatment adherence, functional decline, and an increased risk of recurrent hospitalizations. CA is a frequent and disabling problem among patients with non-cardiac chest pain (NCCP). Cognitive-behavioural therapy (CBT), including internet-delivered CBT (iCBT), may reduce cardiac anxiety; however, evidence remains limited and has not been synthesized systematically using cardiac anxiety-specific outcomes.
Objective
To evaluate the effectiveness of CBT-based interventions, including iCBT, in reducing cardiac anxiety in adults with NCCP, as measured by the Cardiac Anxiety Questionnaire (CAQ).
Methods
A systematic literature search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library. Randomized controlled trials (RCTs) evaluating CBT-based interventions for NCCP and reporting CAQ outcomes were included. Effect sizes were calculated as Hedges’ g (standardized mean difference, SMD) and pooled using a random-effects model at post-treatment and follow-up time points (3 and 12 months). Risk of bias was assessed using the Cochrane RoB 2 tool, and methodological quality was additionally evaluated with the Jadad scale.
Results
The search identified 1,381 records; four RCTs met the inclusion criteria and were included in the meta-analysis. Across all included trials, 165 participants were allocated to the intervention groups and 167 to the control groups. In the pooled sample, women were slightly overrepresented in both study arms (intervention: 88/165, 53.7%; control: 91/167, 54.5%). At post-treatment (k=4), CBT-based interventions were associated with a slight, non-significant reduction in cardiac anxiety compared with control conditions (SMD [Hedges’ g] = −0.10, 95% CI −0.33 to 0.13; I² = 0%) [Fig.1]. At 3-month follow-up (k=2), the pooled effect favoured CBT-based interventions but remained non-significant (SMD = −0.21, 95% CI −0.58 to 0.17; I² = 47.9%). At 12-month follow-up (k=2), the pooled effect likewise favoured CBT-based interventions and remained non-significant (SMD = −0.21, 95% CI −0.56 to 0.15; I² = 41.1%). All studies were judged to present some concerns about bias, primarily due to a lack of blinding and reliance on self-reported outcomes; Jadad scores ranged from 2 to 3.
Conclusions
Across time points, pooled effects consistently favoured CBT-based interventions, suggesting a potential reduction in cardiac anxiety in patients with HF and CCD; however, confidence intervals included the null effect, and follow-up analyses were based on only two trials, limiting statistical certainty and precision.Fig.1.Forest plot of the effects of CBTFor image description, please refer to the figure legend and surrounding text.