Reducing Emotional Distress Improves Prognosis in Coronary Heart Disease

Abstract

Background The impact of treating emotional distress on prognosis in coronary heart disease (CHD) has not been documented convincingly. We tested the hypothesis that treatment-related changes in emotional distress may explain the beneficial effect of rehabilitation on prognosis. Methods and Results In this nonrandomized clinical trial, 150 men with CHD participated in rehabilitation (n=78) or received standard medical care (n=72). There were no differences between rehabilitation and control patients with regard to left ventricular ejection fraction (LVEF) or standard care. End points were reduction in distress after 3 months and mortality after 9 years. At the end of the 3-month trial, 64 patients (43%) reported improvement and 22 (15%) reported deterioration in negative affect. Rehabilitation patients improved more ( P =0.004) and deteriorated less ( P =0.001) than control patients; rehabilitation was effective in reducing distress. After 9 years of follow-up, 15 patients had died (13 cardiac and 2 cancer deaths). Mortality was associated with LVEF ≤50% ( P =0.038) and deterioration in negative affect ( P =0.007). Rate of death was 17% (12/72) for control patients versus 4% (3/78) for rehabilitation patients ( P =0.009); rehabilitation was effective in reducing mortality. LVEF ≤50% (OR 3.2; 95% CI 1.1 to 9.8; P =0.041) and rehabilitation (OR 0.2; 95% CI 0.1 to 0.7; P =0.016) were independent predictors of mortality. Rehabilitation warded off the deleterious effect of deterioration in negative affect on prognosis. Conclusions Deterioration in negative affect is associated with a high long-term mortality risk. Warding off deterioration in negative affect is a mechanism that may explain the beneficial effect of comprehensive rehabilitation on prognosis in patients with CHD.