Long-term effects of a multimodal behavioral intervention on myocardial perfusion--a randomized controlled trial.
BACKGROUND
Recent advances in drug therapy question as to the additional impact behavioral interventions may have on the prognosis of patients with clinically stable coronary heart disease (CHD).


OBJECTIVE
The aim of the study was to evaluate the effects of a multimodal, behavioral intervention on myocardial perfusion (MP) and cardiac events, compared to standardized cardiologic care, in patients with stable CHD.


METHODS
Seventy-seven CHD patients (age 54.2 +/- 6.9 years, male 87%) were randomly assigned to a behavioral intervention plus standardized cardiologic care (INT, n = 39) or standardized cardiologic care alone (CO, n = 38). MP was assessed by (201)Thallium MP-scintigrams (SPECT) at baseline, after 2, 3, and 7 years, respectively. Subsequent cardiac events (MI, PCI, CABG) were assessed using the cardiologists' charts.


RESULTS
Sixty-five patients (84%) completed the study. In all patients, the course of MP was significantly better in INT analysis of variance (ANOVA group x time p = 0.001); this was also true for patients without subsequent PCI/CABG (ANOVA group x time p = 0.002). Incidence of cardiac events was significantly associated with INT (6 vs. 14; log rank test p = .047).


CONCLUSIONS
The study suggests additional long-term benefits of a behavioral intervention on myocardial perfusion and cardiac events in patients with stable CHD compared to standardized cardiologic care only.
Department of Psychosomatics and Psychotherapy, University of Cologne, 50924, Cologne, Germany. christian.albus@uk-koeln.de
Christian
C
Albus
Peter
P
Theissen
Martin
M
Hellmich
Reinhard
R
Griebenow
Beate
B
Wilhelm
Demet
D
Aslim
Harald
H
Schicha
Karl
K
Köhle
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000523:psychology; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000523:psychology; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000523:psychology / Q000628:therapy*; D015444:Exercise / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control / Q000523:psychology; D055414:Myocardial Perfusion Imaging; D010353:Patient Education as Topic; D011615:Psychotherapy, Group; D012064:Relaxation Therapy; D015899:Tomography, Emission-Computed, Single-Photon