Brief psychological intervention in phase I of cardiac rehabilitation after acute coronary syndrome. A Behavior Change Intervention for Women in Cardiac Rehabilitation Psychological effects of a short behavior modification program in patients with acute myocardial infarction or coronary artery bypass grafting. A randomized controlled trial. The UPBEAT Nurse-Delivered Personalized Care Intervention for People with Coronary Heart Disease Who Report Current Chest Pain and Depression: A Randomised Controlled Pilot Study Text Message and Internet Support for Coronary Heart Disease Self-Management: Results From the Text4Heart Randomized Controlled Trial Effect of intervention for psychological distress on rehospitalization rates in cardiac rehabilitation patients. Effects of a psychosocial skills training workshop on psychophysiological and psychosocial risk in patients undergoing coronary artery bypass grafting. Effects of a health advocacy, counselling, and activation programme on depressive symptoms in older coronary heart disease patients. Effects of a psychoeducational intervention for secondary prevention in Korean patients with coronary artery disease: a pilot study. A pilot randomised controlled trial of personalised care for depressed patients with symptomatic coronary heart disease in South London general practices: the UPBEAT-UK RCT protocol and recruitment Behavioural intervention to increase physical activity among patients with coronary heart disease: protocol for a randomised controlled trial. Comparing multifactorial lifestyle interventions and stress management in coronary risk reduction Evaluating the efficacy of an education and treatment program for patients with coronary heart disease. Changing coronary heart disease risk-factor status: The effects of three behavioral programs Cognitive-behavioural rehabilitation programme for patients with an implanted cardioverter defibrillator: a pilot study. Coronary Heart Disease Risk Reduction Intervention Among Overweight Smokers with a Psychotic Disorder: Pilot Trial Inpatient psychotherapeutic treatment for cardiac patients with depression in Germany - short term results
INTRODUCTION Acute coronary syndrome ( ACS ) is an important cause of mortality and significant personal and financial costs . Cardiac rehabilitation ( CR ) programs have shown positive effects in reducing cardiovascular mortality and improving functional capacity . However , adherence is low and appears to be influenced by psychosocial factors , such as patients ' cognitions and emotional state . The objective was to evaluate the efficacy of a brief in-hospital psychological intervention to promote cognitive and emotional adaptation after ACS . METHODS One hundred and twenty-one patients with ACS , admitted to a coronary care unit in a central hospital , were r and omized to an experimental group ( EG , n=65 ) and a control group ( CG , n=56 ) . Portuguese versions of the HADS and BIPQ  were used to measure emotional well-being and illness cognitions . Two 1 h 15 min sessions were conducted 2 - 3 days after hospital admission , and a 20-minute follow-up session took place one month after discharge . Patients were assessed at four different time points : pre-test , post-test , and at 1- and 2-month follow-up . RESULTS The intervention had significant effects on anxiety , depression and illness cognitions . Anxiety and depression were significantly reduced and illness cognitions improved significantly in the EG compared to the control group . For the EG , these changes were maintained or enhanced at 1- and 2-month follow-up , whereas for the CG there was a deterioration in psychosocial adjustment . CONCLUSIONS These results indicate that a brief psychological intervention program delivered during hospitalization for ACS and combined with st and ard medical care can have positive effects in terms of psychosocial outcomes that have proven impact on cardiac rehabilitation and prognosis There is undeniable evidence for physical and psychosocial benefits of cardiac rehabilitation programs for individuals suffering from coronary heart disease . Yet , fewer women than men are referred to , begin , or complete cardiac rehabilitation programs . The numerous logistical , economic , and motivational barriers to healthy behavior change place women at risk for subsequent CHD events . To close this gender gap and improve outcomes , novel , efficacious , and individualized rehabilitative approaches for women with coronary heart disease are needed . The purpose of this article is to describe a theory-driven behavioral intervention design ed exclusively for women with coronary heart disease . The 12-week intervention is being tested in a r and omized controlled trial involving women referred to a cardiac rehabilitation program .  The tenets of the Transtheoretical Model of behavior change and motivational interviewing guided the development and implementation of the stage-matched , individualized intervention to promote healthy behavior change for women with coronary heart disease . The ongoing trial will examine the efficacy of the intervention on physiological and psychosocial outcomes OBJECTIVE The effects of a short intervention on behavioral risk factor modification in patients with coronary artery disease ( CAD ) on Type A behavior , vital exhaustion , and depression were studied in a r and omized controlled trial . METHODS Acute myocardial infa rct ion patients or patients who underwent coronary artery bypass grafting ( CABG ) were r and omly assigned to an 8-week multiple risk modification group program ( n = 94 ) or to a control group ( n = 90 ) that received usual care with st and ard physical exercise training . Patients were assessed before intervention , directly after intervention , and at 9-month follow-up . RESULTS The intervention was effective in reducing hostility and total Type A behavior at postintervention ( P = .01 ) and at 9-month follow-up ( P = .03 ) . The intervention had no overall impact on vital exhaustion and depression , measured by the Beck Depression Inventory ( BDI ) , whereas we unexpectedly found that the percentage of patients with major depression was reduced in the control group but not in the intervention group . CONCLUSION The results indicate that a short behavioral intervention for coronary patients can result in relatively large and persistent reductions in cognitive aspects of Type A behavior and hostility , in particular . In view of the unwanted findings on the diagnosis of depression , however , we do not unequivocally advise the intervention to the general population of AMI and CABG patients Background Depression is common in people with coronary heart disease ( CHD ) and associated with worse outcome . This study explored the acceptability and feasibility of procedures for a trial and for an intervention , including its potential costs , to inform a definitive r and omized controlled trial ( RCT ) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression . Methods Multi-centre , outcome assessor-blinded , r and omized parallel group study . CHD patients reporting chest pain and scoring 8 or more on the HADS were r and omized to personalized care ( PC ) or treatment as usual ( TAU ) for 6 months and followed for 1 year . Primary outcome was acceptability and feasibility of procedures ; secondary outcomes included mood , chest pain , functional status , well being and psychological process variables . Result 1001 people from 17 General Practice CHD registers in South London consented to be contacted ; out of 126 who were potentially eligible , 81 ( 35 % female , mean age = 65 SD11 years ) were r and omized .  PC  participants ( n = 41 ) identified wide ranging problems to work on with nurse-case managers . Good acceptability and feasibility was indicated by low attrition ( 9 % ) , high engagement and minimal nurse time used ( mean/SD = 78/19 mins assessment , 125/91 mins telephone follow up ) . Both groups improved on all outcomes . The largest between group difference was in the proportion no longer reporting chest pain  ( PC 37 % vs TAU 18 % ; mixed effects model OR 2.21 95 % CI 0.69 , 7.03 ) . Some evidence was seen that self efficacy ( mean scale increase of 2.5 vs 0.9 ) and illness perceptions ( mean scale increase of 7.8 vs 2.5 ) had improved in PC vs TAU participants at 1 year . PC appeared to be more cost effective up to a QALY threshold of approximately £ 3,000 . Conclusions Trial and intervention procedures appeared to be feasible and acceptable . PC allowed patients to work on unaddressed problems and appears cheaper than TAU . Trial Registration Controlled-Trials.com IS RCT Background Mobile technology has the potential to deliver behavior change interventions ( mHealth ) to reduce coronary heart disease ( CHD ) at modest cost . Previous studies have focused on single behaviors ; however , cardiac rehabilitation ( CR ) , a component of CHD self-management , needs to address multiple risk factors . Objective The aim was to investigate the effectiveness of a mHealth-delivered comprehensive CR program ( Text4Heart ) to improve adherence to recommended lifestyle behaviors ( smoking cessation , physical activity , healthy diet , and nonharmful alcohol use ) in addition to usual care ( traditional CR ) . Methods A 2-arm , parallel , r and omized controlled trial was conducted in New Zeal and adults diagnosed with CHD . Participants were recruited in-hospital and were encouraged to attend center-based CR ( usual care control ) . In addition , the intervention group received a personalized 24-week mHealth program , framed in social cognitive theory , sent by fully automated daily short message service ( SMS ) text messages and a supporting website . The primary outcome was adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score ( ≥3 ) at 3 and 6 months . Secondary outcomes included clinical outcomes , medication adherence score , self-efficacy , illness perceptions , and anxiety and /or depression at 6 months . Baseline and 6-month follow-up assessment s ( unblinded ) were conducted in person . Results Eligible patients ( N=123 ) recruited from 2 large metropolitan hospitals were r and omized to the intervention ( n=61 ) or the control ( n=62 ) group . Participants were predominantly male ( 100/123 , 81.3 % ) , New Zeal and European ( 73/123 , 59.3 % ) , with a mean age of 59.5 ( SD 11.1 ) years . A significant treatment effect in favor of the intervention was observed for the primary outcome at 3 months ( AOR 2.55 , 95 % CI 1.12 - 5.84 ; P=.03 ) , but not at 6 months ( AOR 1.93 , 95 % CI 0.83 - 4.53 ; P=.13 ) . The intervention group reported significantly greater medication adherence score ( mean difference : 0.58 , 95 % CI 0.19 - 0.97 ; P=.004 ) . The majority of intervention participants reported reading all their text messages ( 52/61 , 85 % ) . The number of visits to the website per person ranged from zero to 100 ( median 3 ) over the 6-month intervention period . Conclusions A mHealth CR intervention plus usual care showed a positive effect on adherence to multiple lifestyle behavior changes at 3 months in New Zeal and adults with CHD compared to usual care alone . The effect was not sustained to the end of the 6-month intervention . A larger study is needed to determine the size of the effect in the longer term and whether the change in behavior reduces adverse cardiovascular events . Trial Registration ACTRN 12613000901707 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=364758&is Review = true ( Archived by WebCite at http://www.webcitation.org/6c4qhcHKt Psychosocial factors affect the development of coronary heart disease and morbidity and mortality of patients with known coronary heart disease . A prior study has shown that psychological distress in patients with known coronary heart disease increased medical and economic costs . This study examined the effects of commonly available psychological interventions offered to patients entering cardiac rehabilitation after hospitalization for angina , myocardial infa rct ion , angioplasty , or coronary artery bypass grafting . A total of 380 patients were screened with the Symptom Checklist-90-Revised ( SCL-90-R ) . Those with T-scores > or = 63 ( > or = 91 percentile ) on the General Severity Index ( GSI ) subscale were r and omly assigned to usual care or special intervention . Special intervention included a psychiatric evaluation , plus one to seven sessions of behavioral therapy . The percentage of patients rehospitalized for cardiac symptoms within 12 months of psychological evaluation was 43 % for special intervention and 40 % for usual care ( NS ) . A correction for crossover between the treatment groups result ed in a favorable trend toward intervention , with 35 % of the psychologically treated patients rehospitalized vs. 48 % of the untreated patients ( NS ) . Although there was a nonsignificant reduction of the SCL-90-R 's GSI T-score , the depression score was significantly reduced in the special intervention group Substantial evidence links high levels of hostility , stress , depression , and social isolation with increased risk of cardiovascular disease ( CVD ) , along with poorer prognosis after myocardial infa rct ion ( MI ) . Further , these variables have been shown to cluster in particular individuals , producing even greater risk . One of the mechanisms thought to link psychosocial factors with CVD is cardiovascular reactivity ( CVR ) . Exaggerated CVR to stress has been shown to be associated with accelerated atherosclerosis , increased CVD risk , and stroke incidence . Interventions for reducing psychosocial coronary risk factors and promoting recovery from coronary heart disease ( CHD ) have included both educational programs aim ed at lifestyle and behavior change and cognitivebehavioral interventions targeted at changing specific psychosocial risk factors such as hostility . A recent meta- analysis found that stress management and educational programs for CHD patients significantly reduced blood pressure ( BP ) , cholesterol , body weight , and emotional distress and lowered the recurrence of MI and mortality by 29 % and 34 % , respectively . However , not all of the trials evaluating these interventions have been r and omized , and some have had small sample sizes . In addition , a number of these interventions have been targeted at patients identified as being at high psychosocial risk , which raises questions about the extent to which the effectiveness of such programs is limited to high-risk patients as compared with the patient OBJECTIVES To describe the effects of a health advocacy , counselling , and activation programme on depressive symptoms among older coronary heart disease ( CHD ) patients . METHODS A r and omised , controlled intervention study in Lieto , South-western Finl and . Older ( 65 years and older ) patients with CHD were r and omly divided into an intervention group ( IG ) ( n = 116 ) and a control group ( CG ) ( n = 106 ) . Outcome measures comprised changes in depressive symptoms ( Zung Self-rating Depression Scale , ZSDS ) . RESULTS Depressive symptoms tended to decrease in IG and to increase in CG among men scoring 45 ZSDS sum points or more at baseline . The differences of the changes between IG and CG were significant in favour of IG . No similar changes were found among women . CONCLUSIONS A health advocacy , counselling , and activation programme aim ed to increase knowledge about CHD , social activities , contacts , roles , support , and exercising was effective in reducing depressive symptoms among male CHD patients suffering from a moderate or high amount of depressive symptoms This intervention study was design ed to examine whether a 12-week psychoeducational intervention influenced recurrent cardiac events , symptom experience and treatment adherence of patients with coronary artery disease . Fifty-eight patients were r and omized to either the intervention or the control group . Measures were taken at baseline , after intervention , and at 6-month follow-up . Recurrent cardiac events included revascularization , rehospitalization , emergency room visits and mortality . Symptom experiences were measured using the Seattle Angina Question naire-Korean and Hospital Anxiety and Depression Scale . Treatment adherence included  health behaviours , routine check-up and medication adherence .  At 6-month follow-up , the intervention group had significantly better physical functions and lower anxiety and depressive symptoms . Treatment adherence was also significantly higher in the intervention group than the control group . No significant difference was noticed in the incidence of recurrent cardiac events between the groups . A longer follow-up study is needed to determine the long-term effects on the prevention of recurrent cardiac events Background Community studies reveal people with coronary heart disease ( CHD ) are twice as likely to be depressed as the general population and that this co-morbidity negatively affects the course and outcome of both conditions . There is evidence for the efficacy of collaborative care and case management for depression treatment , and whilst NICE guidelines recommend these approaches only where depression has not responded to psychological , pharmacological , or combined treatments , these care approaches may be particularly relevant to the needs of people with CHD and depression in the earlier stages of stepped care in primary care setting s. Methods This pilot r and omised controlled trial will evaluate whether a simple intervention involving a personalised care plan , elements of case management and regular telephone review is a feasible and acceptable intervention that leads to better mental and physical health outcomes for these patients . The comparator group will be usual general practitioner ( GP ) care.81  participants have been recruited from CHD registers of 15 South London general practice s. Eligible participants have probable major depression identified by a score of ≥8 on the Hospital Anxiety and Depression Scale depression subscale ( HADS-D ) together with symptomatic CHD identified using the Modified Rose Angina Question naire . Consenting participants are r and omly allocated to usual care or the personalised care intervention which involves a comprehensive assessment of each participant ’s physical and mental health needs which are documented in a care plan , followed by regular telephone review s by the case manager over a 6-month period . At each review , the intervention participant ’s mood , function and identified problems are review ed and the case manager uses evidence based behaviour change techniques to facilitate achievement of goals specified by the patient with the aim of increasing the patient ’s self efficacy to solve their problems . Depressive symptoms measured by HADS score will be collected at baseline and 1 , 6- and 12 months post r and omisation . Other outcomes include CHD symptoms , quality of life , wellbeing and health service utilisation . Discussion This practical and patient-focused intervention is potentially an effective and accessible approach to the health and social care needs of people with depression and CHD in primary care . Trial registration IS RCT N21615909 BACKGROUND Although physical activity has significant health benefits in the treatment of patients with coronary heart disease , patients often do not follow prescribed physical activity recommendations . Behavioural strategies have been shown to be efficacious in increasing physical activity among those patients with coronary heart disease who are attending structured cardiac rehabilitation programmes . Research has also shown that tailoring consultation according to patients ' needs and sending motivational reminders are successful ways of motivating patients to be physically active . However , there is a lack of evidence for the efficacy of behavioural interventions based on individualised consultation in promoting physical activity among those patients with coronary heart disease who are not attending structured physical activity programmes . OBJECTIVE This paper outlines the study protocol for a trial which is currently underway , to examine the effect of a behavioural change intervention delivered through individualised consultation calls and motivational reminder text messages on the level of physical activity among patients with coronary heart disease . SETTING Two large hospitals in Jordan . PARTICIPANTS Eligible patients aged between 18 and 70 years , who are clinical ly stable , are able to perform physical activity and who have access to a mobile telephone have been r and omly allocated to control or intervention group . DESIGN AND METHODS Two-group r and omised controlled trial . Behavioural intervention will be compared with usual care in increasing  physical activity levels among patients with coronary heart disease . The control group ( n=85 ) will receive advice from their doctors about physical activity as they would in usual practice . The intervention group ( n=71 ) will receive the same advice , but will also receive behavioural change intervention ( goal - setting , feed-back , self-monitoring ) that will be delivered over a period of six months . Intervention will be delivered through individually tailored face-to-face and telephone consultations , supported by motivational SMS text messages to encourage and remind patients to attain these goals . The participants and the research er delivering the intervention are not blinded to group assignment . RESULTS Recruitment started in February 2012 and preliminary findings are expected in November 2012 . CONCLUSION It is hypothesised that behavioural intervention delivered through tailored individualised consultation supported by motivational SMS text message reminders will help CHD patients to increase their level of PA . TRIAL REGISTRATION The study is registered as a clinical trial at IS RCT N register ( IS RCT N48570595 ) The aim of this study was to compare the effects of residential multifactorial cardiac rehabilitation , outpatient multifactorial rehabilitation , stress management , and st and ard coronary rehabilitation , on cardiac risk reduction . Out of 144 eligible male patients recently treated with percantaneous transluminal coronary angiography ( PTCA ) , coronary artery bypass graft ( CABG ) , or acute myocardial infa rct ion ( AMI ) , 132 were r and omized into this study . All interventions covered a 12-month active intervention , intense during the first months and subsequently leveled out . Main assessment s were performed before r and omization and after the intervention . Patients offered behavioral rehabilitation showed improved selfreported healthy diet habits and exercise frequency , and higher internal locus of control . Although blood lipids , exercise capacity , body mass , anxiety , depression , and Type A scores were changed in the expected direction , no significant difference emerged between active intervention and the st and ard care condition . St and ard care of today appears to have great potential in particular if supplemented with some kind of stress management BACKGROUND Until now , there has not been any evaluated , disease-specific education and treatment program for patients with coronary heart disease ( CHD ) in Germany . It is thought that education can improve these patients ' physical activity and quality of life and teach them how to lessen their risk factors , what to do in case of an emergency , and how to assess their own medical treatment . METHODS A r and omized controlled open intervention trial was carried out from February 2010 to September 2011 . 196 patients were assigned to receive the intervention ( patient education ) , while 199 were assigned to a control group .  In an intention-to-treat analysis , baseline and follow-up data were compared after a mean interval of 220 days . The evaluative instruments included the Freiburg Question naire of Physical Activity , the MacNew Heart Disease Quality of Life Question naire , question naires regarding knowledge about CHD , ergometric performance ability , and the body-mass index . RESULTS The patients in the intervention group reported having increased their physical activity by a mean of 9.3 MET/week ( MET = metabolic equivalent of task ) , compared to 2.5 MET/week in the control group ; the difference of 6.8 MET/week was statistically significant ( p = 0.015 ) . The patients in the intervention group also rated their quality of life higher than those in the control group ( 0.2 ± 0.56 vs. 0.09 ± 0.53 [ mean ± st and ard deviation ] , p = 0.056 ) . They were significantly better informed than patients in the control group about risk factors and about what to do in an emergency . CONCLUSION Persistently unhealthy lifestyle is a common problem of CHD patients ; the education and treatment program presented here may be a suitable means of improving patients ' lifestyle for secondary prevention . Further studies will be needed to document long-term efficacy and to determine whether occasional refresher courses will be needed as well Seventy-five persons ( 57 male and 18 female ) with a high risk of coronary heart disease ( CHD ) were r and omly assigned in equal numbers to three 8-week behavioral treatment programs . All three treatments were design ed to alter simultaneously a number of risk-elevating behavior patterns , in the expectation that change in any one behavior pattern would reinforce change in others . Weight , blood pressure , and aerobic fitness were regularly assessed in all subjects . Serum lipids were also measured , but less frequently . All three interventions produced significant beneficial changes in the major objective measures , and the changes were well maintained after 12 months . The most improved group exhibited the following mean changes : weight loss of 9.2 kg , reductions in blood pressure of 12.9/8.8 mm Hg , improvement in aerobic capacity of 33 % , reduction in serum cholesterol of 0.45 mmol/liter , and reduction in current overall CHD risk of 41 % . The effectiveness of the interventions was positively related to the degree to which the programs emphasized training in , and detailed application of , behavioral change principles OBJECTIVES The effectiveness of a comprehensive 12-week CR programme for ICD patients was evaluated . DESIGN All surviving and suitable ICD patients being cared for by a regional implantation centre were invited to attend a 12-week cognitive-behavioural cardiac rehabilitation programme that had been modified to meet the needs of this group . Patients assenting were r and omized to either an immediate treatment or a waiting treatment group . Measures were taken prior to r and omization , at the end of the treatment or waiting period , at the end of the second treatment group for that group only and at three months post-treatment for both groups . OUTCOME MEASURES The Hospital Anxiety and Depression Scale , the Total Concerns Question naire , the Quality of Life after Myocardial Infa rct ion Question naire , the EuroQual ( subjective health rating scale ) , the Shuttle Test and a number of ICD shocks and ATP episodes were used in this study . RESULTS For those patients willing and able to attend , the cognitive-behavioural CR programme produced significant benefits in terms of psychological and functional adaptation to living with the device . CONCLUSIONS A comprehensive 12-week CR programme that incorporated both psychological and exercise-based components significantly reduced anxiety and depression and improved quality of life of ICD patients . It is not clear if these benefits are sustained Objective : The aim of the present pilot study was to test the feasibility and short-term impact of a multi-component risk factor intervention for reducing ( i ) coronary heart disease ( CHD ) risk ; ( ii ) smoking ; and ( iii ) weight among smokers with psychosis . Secondary dependent variables included physical activity , unhealthy eating , substance use , psychiatric symptomatology , treatment retention , general functioning , and quality of life . Method : This was a feasibility study utilizing a pre – post-treatment design with  no control group ( n=43 ) . All participants provided written informed consent and were assessed before treatment and again a mean of 19.6weeks later . The treatment consisted of nine individual 1h sessions of motivational interviewing and cognitive behaviour therapy plus nicotine replacement therapy , in addition to treatment as usual . Research assistants who had not been involved in the delivery of the treatment programme conducted post-treatment assessment s. Results : The intervention was associated with significant reductions in CHD risk scores , smoking and weight . A significant improvement was also reported in level of moderate physical activity , and a small change in the unhealthy eating index was reported . No improvement in biological measures ( cholesterol and blood pressure ) was evident . Conclusions : A multi-component CHD risk factor intervention among smokers with psychosis appears to be feasible and effective in the short-term . A r and omized controlled trial replicating and extending these findings is warranted The purpose of the PROTeCD(Psychotherapeutic Re source -Orientated Treatment for Cardiac Patients with Depression)- study was to develop and to evaluate a brief psychotherapeutic intervention for rehabilitation in- patients with coronary heart disease ( CHD ) and depressive disorders . In three cardiac rehabilitation hospitals all patients were screened for mental distress at admission . Patients generally stay for 3 to 4 weeks before being referred to outpatient care . Method : Those patients with elevated distress were interviewed for mental disorders and took part in the baseline- assessment . Patients diagnosed with a depressive disorder at baseline were r and omised into the intervention or the usual care group .  Efficacy was assessed at discharge from hospital ( short-term ) . 59 subjects with CHD and co-morbid depressive disorder were r and omised into the trial - 27 into the intervention group ( IG ) and 32 into the usual care group ( UC ) . Patients in the intervention group received 4 to 6 individual psychotherapeutic sessions of 50 minutes each , including patient education and cognitive-behavioural treatment of depression . Outcome measures were depressive and anxiety symptoms in self report and interview . Results : There was no significant difference between intervention and usual care group in this short-term reduction of depressive symptoms , mental distress and anxiety . However , at discharge the patients still suffer from an increased level of distress compared to the recommended cut off scores of the assessment scales . Conclusion : Multimodal inpatient rehabilitation reduces depressive and anxiety symptoms in depressed CHD patients in short term independently of an additional psychotherapeutic intervention
Conclusions We found that psychological intervention  improved psychological symptoms and reduced cardiac mortality for people with CHD .
However , there remains considerable uncertainty regarding the magnitude of these effects and the specific techniques most likely to benefit people with different presentations of CHD
Background Although psychological interventions are recommended for the management of coronary heart disease ( CHD ) , there remains considerable uncertainty regarding their effectiveness .