Short-term psychotherapy improved outcomes post-MI

Roncella A et al. Int J Cardiol. 2013; 170(2):132-139.

  • December 11, 2013

Adding short-term psychotherapy to standard cardiac therapy improved medical symptoms, psychological symptoms and quality of life, and reduced rehospitalizations 1 year post-acute MI, findings from the STEP-IN-AMI trial indicate.

Among 94 patients with recent acute MI, those who underwent short-term humanistic-existential psychotherapy (STP) had lower incidence of new cardiac events compared with controls (43% vs. 78%, P=.0006) after 1 year,  according to Adriana Roncella, MD, of the interventional cardiology unit at the San Filippo Neri Hospital in Rome, Italy, and colleagues.

Patients in the STP-intervention group also had fewer rehospitalizations, a better NYHA class, higher quality of life and lower depression scores, the researchers reported in the International Journal of Cardiology.

From June 2009 to January 2011, Roncella and colleagues enrolled patients who underwent revascularization with urgent or emergent angioplasty for acute MI. They were assigned to STP plus standard cardiac care (n=49) or standard cardiac care alone (n=45). 

The primary endpoint was a composite of reinfarction, death, stroke, revascularization, life-threatening ventricular arrhythmias, recurrence of clinically significant angina and new comorbidities.

Secondary endpoints were rates of individual components of the composite primary endpoint, rehospitalization due to cardiac problems, NYHA class and psychometric test scores at 1-year follow-up.

Patients were similar in terms of clinical, angiographic and psychometric characteristics and had similar pharmacological therapies at discharge. More patients in the control group were prescribed nitrates.

At 1 year, patients assigned to the STP intervention along with standard cardiac rehabilitation had a 35% absolute risk reduction in primary endpoint incidence, with a number needed to treat of three patients (95% CI: 1.9 to 6.1), the researchers reported.

Patients in the STP group had statistically significantly lower rates of rehospitalization (mean 0.77 vs. 1.2; P=.02), as well as a better average NYHA class (1 vs. 1.3; P=.01) than the control group, despite similar mean ejection fractions (56 in each group) and wall motion score-indices (1.4 vs. 1.43; P=.72) at follow-up.

Furthermore, more patients in the control group needed an increase in diuretic, beta-blocker or vasoactive medication doses compared with the STP group (78% vs. 31%; P <.0001).

Although the difference was not statistically significant, there were three episodes of life-threatening arrhythmias and three patients who required psychiatric drugs or treatment for major depression or general anxiety disorder in the control group, compared with none in the STP group.

In terms of psychological and quality-of-life outcomes, patients in the STP group had significantly lower Beck Depression Inventory (BDI) scores (14% vs. 27% with a BDI >10; P=.03) and lower overall prevalence of severe depression (4% vs. 20%; P=0.01).

“In our 1-year analysis of the STEP-IN-AMI trial, we demonstrated that adding STP on top of standard cardiological care early after an acute MI treated with urgent/emergent PCI yields a striking reduction in the incidence of primary composite cardiological and medical endpoints, such that only three subjects need to be treated before one less event is noted,” the researchers concluded.

An ongoing analysis with a planned 5-year follow-up period is currently underway to assess longer-term outcomes. The researchers called for larger studies to confirm the generalizability of the findings.

Disclosure: The researchers report no relevant financial disclosures.

Comments

Healio is intended for health care provider use and all comments will be posted at the discretion of the editors. We reserve the right not to post any comments with unsolicited information about medical devices or other products. At no time will Healio be used for medical advice to patients.