Psychosocial nursing therapy following sudden cardiac arrest: impact on two-year survival.
BACKGROUND
Although psychosocial therapy has been shown to reduce mortality after myocardial infarction, it is unknown whether the benefits of psychosocial therapy on mortality reduction extend to out-of-hospital sudden cardiac arrest, a main cause of cardiovascular mortality.


OBJECTIVE
Describe efficacy of psychosocial therapy on two-year cardiovascular mortality in sudden cardiac arrest survivors.


METHODS
Survivors of out-of-hospital ventricular fibrillation or asystole (N = 129), documented by electrocardiograms from registries of a citywide Medic One unit and two countywide emergency units, were randomized into a two group, experimental, longitudinal design. The intervention consisted of 11 individual sessions, implementing three components: physiologic relaxation with biofeedback training focused on altering autonomic tone; cognitive behavioral therapy aimed at self-management and coping strategies for depression, anxiety, and anger; and cardiovascular health education. The primary outcome measure was cardiovascular mortality.


RESULTS
Risk of cardiovascular death was significantly reduced 86% by psychosocial therapy, p = .03. Six of the seven cardiovascular deaths in the control group were caused by ventricular arrhythmias. The cardiovascular death in the therapy group was due to stroke. Controlling for depression, previous myocardial infarction, low ejection fraction, decreased heart rate variability, and ventricular ectopic beats had little impact on estimated treatment effect. The risk of all-cause mortality was reduced by 62% in the therapy group, p = .13. There were a total of three deaths in the therapy group and eight deaths in the control group.


CONCLUSIONS
Psychosocial therapy significantly reduced the risk of cardiovascular death in sudden cardiac arrest survivors.
Cowan
M J
MJ
School of Nursing, University of California at Los Angeles, 90095-1702, USA.
Pike
K C
KC
Budzynski
H K
HK
D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001676:Biofeedback, Psychology; D002423:Cause of Death; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000451:nursing* / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015403:Nursing Evaluation Research; D010353:Patient Education as Topic / Q000379:methods; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011615:Psychotherapy, Group / Q000379:methods*; D012064:Relaxation Therapy; D012307:Risk Factors; D012648:Self Care / Q000379:methods / Q000523:psychology; D016019:Survival Analysis; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome