[Psychological interventions in the rehabilitation of patients with coronary heart disease: summary of evidence and recommendations from systematic reviews and guidelines].
OBJECTIVE
To summarize national and international evidence and recommendations for psychological interventions in the rehabilitation of patients with coronary heart disease. Background is a project for the development of evidence-based practice guidelines for psychological interventions in the rehabilitation of patients with coronary heart disease.


METHODS
A systematic literature search in several databases and on the websites of professional associations was conducted in order to identify relevant reviews and guidelines. A handsearch was conducted in addition to the electronic search. Eligible publications were selected, and evidence for psychological interventions was extracted as well as recommendations relative to psychological diagnostics or interventions.


RESULTS
5 systematic reviews and 34 guidelines were included. Recommendations and (partially restricted) evidence from systematic reviews was found for the following psychological interventions: patient counselling and health education; screening and treatment of comorbid psychological disorders; occupational counselling; stress management; relaxation training; interventions for smoking cessation; interventions promoting appropriate nutrition and weight management; interventions enhancing sufficient, regular physical activity; interventions enhancing social support; specific interventions for women; involvement of family members or partners; discussion of sexual activity.


CONCLUSIONS
For several psychological interventions in the treatment of patients with coronary heart disease we found empirical evidence from systematic reviews. For other psychological interventions, no empirical evidence from systematic reviews was found. The summary of guidelines shows that both in Germany and abroad, a number of psychologically grounded interventions are an inherent part of cardiac rehabilitation. However, many recommendations which refer to psychological diagnostics and interventions are not precise enough to guide psychological care of individual patients. In particular, there are no statements in many guidelines on which (psychological) treatments should be considered for which problems. Moreover, hardly any evidence or recommendations were found for specific interventions referring to special groups of patients (e.g., women, patients with low socio-economic status or migration background). Further research is needed in these respects in order to answer questions concerning the indication and effectiveness of such tailored interventions.
Universitätsklinikum Freiburg, Abteilung Qualitätsmanagement und Sozialmedizin, Freiburg, Germany. christina.reese@uniklinikfreiburg.de
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D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000534:rehabilitation*; D006801:Humans; D015994:Incidence; D038622:Internationality; D001523:Mental Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D017410:Practice Guidelines as Topic; D011613:Psychotherapy / Q000706:statistics & numerical data*; D012307:Risk Factors