Meditation and Secondary Prevention of Depression and Anxiety in Heart Disease: A Systematic Review

Sunday, 22 July 2018: 1:50 PM

Angela Rao, BSN (Hons)1
Michelle DiGiacomo, PhD, MHSc (Hons), BA1
Phillip J. Newton, PhD2
Jane L. Phillips, PhD1
Louise D. Hickman, PhD, MPH, BN, RN1
(1)Improving Palliative, Aged and Chronic Care Through Clinical and Research Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, Australia
(2)Nursing Research Centre, Western Sydney University; Western Sydney Local Health District, Blacktown, Australia

Background: Heart disease remains the leading cause of global mortality, accounting for 17.7 million deaths per year (1). Comorbid depression and anxiety further increases the risk of mortality and adverse cardiac events (2). Depression and anxiety are highly prevalent after an acute cardiac event or hospitalisation, inhibiting many adults from optimising their participation in cardiac rehabilitation programs, and reducing their capacity to understand and effectively self-manage their symptoms. Sustainable adjunct therapies are required to ensure a patient centred approach to heart disease secondary prevention that best addresses the unmet needs of patients for psychological support following their acute cardiac event (3, 4). Meditation is an adjunct therapy recently recognised by the American Heart Association as a viable option for cardiovascular risk reduction and as a psychological support strategy for those interested in lifestyle modification (5). Meditation is derived from Eastern spiritual practices and has been reframed for integration in Western society by way of Mindfulness Based Interventions and Transcendental Meditation, making it an appropriate low cost strategy for implementation globally (6).

Aims: This systematic review aims to: 1) identify high levels of evidence for meditation interventions designed to improve depression and/or anxiety symptoms among adults with heart disease in a health care clinical setting after an inpatient hospitalisation; and 2) classify the elements of meditation that facilitate positive depression and/or anxiety outcomes.

Methods: High level evidence, including randomised controlled trials and quasi-experimental studies published between 1979 and 27th September 2017, in an English peer-reviewed journal were eligible for inclusion. Databases searched included MEDLINE, Embase, CINAHL, PsycInfo, AMED and the Cochrane Database of Systematic Reviews. The data was extracted by two reviewers and checked by a third reviewer to resolve any conflicts. This review conforms to the PRISMA statement and has adhered to the Cochrane Risk of Bias guideline.

Results: Nine studies of meditation interventions were identified, involving 477 participants. Statistically significant outcomes were demonstrated in over half (5/9) of the phase II meditation interventions for depression and/or anxiety outcomes. Meditation interventions that generated positive outcomes for depression and/or anxiety included elements such as: focused attention to body parts (or a body scan) (3/4 studies), and/or group meetings (4/5 studies).

Conclusion: Meditation is a means of reframing heart disease secondary prevention services towards an integrated model of care that incorporates a patient centred approach. Future adequately powered phase III studies are needed to confirm which meditation elements are associated with reductions is depression and anxiety; and the differential effects between concentrative and mindfulness based meditation therapies for specific heart disease populations.

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