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Psychotherapy improves CV outcomes in at-risk patients (SUPRIM)

Clinical Question:
Can cognitive behavioral therapy decrease recurrent cardiovascular events in patients with coronary heart disease?

Bottom Line:
Cognitive behavioral therapy (CBT), administered in group sessions over 1 year, significantly decreased the recurrence of cardiovascular events in patients who'd had a previous event. The CBT was very specifically aimed at stress reduction and may not be widely available. (LOE = 1b-)

Gulliksson M, Burell G, Vessby B, Lundin L, Toss H, Svärdsudd K. Randomized controlled trial of cognitive behavioral therapy vs standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease. Secondary prevention in Uppsala Primary Health Care Project (SUPRIM) Arch Intern Med 2011;171(2):134-140.  [PMID:21263103]

Study Design:
Randomized controlled trial (nonblinded)



Outpatient (specialty)

The Swedish investigators conducting this study enrolled 362 consecutive, eligible patients who were discharged from the hospital following an acute coronary event (eg, infarction, bypass graft, and so forth). The patients were 75 years or younger (average = 61.5 years) and were randomized, using concealed allocation, to receive either usual care or usual care plus group CBT administered in twenty 2-hour sessions over 1 year. The CBT had specific goals, and focused on stress management and reducing the experience of daily stress, time urgency, and hostility. Attendance was high, with 90% of patients attending at least 75% of the sessions. Over an average 7.8 years of follow-up from the time of the first cardiovascular event, 47% of patients in the usual treatment group experienced a recurrent event as compared with 36% in the CBT group (P = .01). In other words, there was 1 fewer event for every 9 patients who received CBT along with usual care, though this number could be much higher (number needed to treat = 9.4; 95% CI, 4.9 - 228). Rates of death were low (1 vs 3) and were not different between the groups. Rates of recurrence were lower for patients who attended sessions more regularly, which may show a benefit of the treatment or may simply be reflect the characteristics of patients who will scrupulously attend this type of session.


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