Randomized Trial of Mindfulness-Based Stress Reduction in Cardiac Patients Eligible for Cardiac Rehabilitation

Sci Rep. 2019 Dec 5;9(1):18415. doi: 10.1038/s41598-019-54932-2.

Abstract

Currently, exercise-based cardiac rehabilitation (CR) is the only recommended secondary prevention strategy for cardiac patients that attempts to tackle stress and psychosocial wellbeing, but it is under-utilized and lacks a comprehensive curriculum for this purpose; hence there is a critical gap to address psychosocial needs of cardiac patients after an event. Mindfulness-based stress reduction (MBSR) has shown benefits in the general population but its role in cardiac patients is not clear. We conducted a pilot randomized controlled trial (RCT) of MBSR in CR-eligible cardiac patients during their initial year of recovery. Patients were allocated 2:1 (intervention:control) to an 8-week MBSR group intervention or usual care. Standard measures of depression, anxiety, perceived stress, health related quality of life (HRQOL), blood pressure, biomarkers (lipids, HbA1c, CRP) and 24-hour Holter monitoring were obtained at baseline, 3- and 9-months post-randomization. Sub-group analyses were performed for participants with at least mild depression (PHQ-9 ≥ 5). 47 patients [mean age 58.6 years; 38% female; 77% white] were enrolled in 2 cohorts. 87% of MBSR patients completed the intervention; study retention was >95% at each follow-up visit. At 3 months, compared to controls, MBSR patients showed improvements in depression [p = 0.01] and anxiety [p = 0.04] with a similar trend in HRQOL [p = 0.06]. The MBSR group showed greater improvement or less worsening of most CV risk factors, with an attenuation of treatment effects at 9 months. Participants with at PHQ-9 scores ≥5 at baseline showed greater improvement in psychosocial and CV outcomes, that persisted at 9 months. MBSR is a safe and well received secondary prevention strategy. This pilot RCT provides preliminary evidence of MBSR's potential to improve short term psychosocial well-being in cardiac patients during their first year of recovery.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anxiety / complications
  • Anxiety / physiopathology
  • Anxiety / psychology
  • Anxiety / rehabilitation*
  • Biomarkers / blood
  • Blood Pressure / physiology
  • C-Reactive Protein / metabolism
  • Cardiac Rehabilitation / methods*
  • Depression / complications
  • Depression / physiopathology
  • Depression / psychology
  • Depression / rehabilitation*
  • Female
  • Glycated Hemoglobin / metabolism
  • Humans
  • Lipids / blood
  • Male
  • Meditation / methods
  • Meditation / psychology
  • Middle Aged
  • Mindfulness*
  • Myocardial Infarction / complications
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / psychology
  • Myocardial Infarction / rehabilitation*
  • Pilot Projects
  • Quality of Life / psychology
  • Secondary Prevention / methods*
  • Stress, Psychological / complications
  • Stress, Psychological / physiopathology
  • Stress, Psychological / psychology
  • Stress, Psychological / rehabilitation*

Substances

  • Biomarkers
  • Glycated Hemoglobin A
  • Lipids
  • hemoglobin A1c protein, human
  • C-Reactive Protein