Randomized Trial of Mindfulness-Based Stress Reduction in Cardiac Patients Eligible for Cardiac Rehabilitation

• Published in: Scientific reports 2019-12, Vol.9 (1), p.18415-11, Article 18415
• Main Authors: Nijjar, Prabhjot S., Connett, John E., Lindquist, Ruth, Brown, Roland, Burt, Marsha, Pergolski, Aaron, Wolfe, Alexandra, Balaji, Priya, Chandiramani, Nitya, Yu, Xiaohui, Kreitzer, Mary Jo, Everson-Rose, Susan A.
• Format: Article
• Language: English
• Subjects: 692/4019; 692/700; Aged; Anxiety; Anxiety - complications; Anxiety - physiopathology; Anxiety - psychology; Anxiety - rehabilitation; Biomarkers; Biomarkers - blood; Blood pressure; Blood Pressure - physiology; C-Reactive Protein - metabolism; Cardiac Rehabilitation - methods; Cardiovascular disease; Clinical trials; Curricula; Depression - complications; Depression - physiopathology; Depression - psychology; Depression - rehabilitation; Design; Enrollments; Feasibility studies; Female; Glycated Hemoglobin A - metabolism; Heart; Humanities and Social Sciences; Humans; Intervention; Lipids; Lipids - blood; Male; Meditation; Meditation - methods; Meditation - psychology; Mental depression; Middle Aged; Mindfulness; multidisciplinary; Myocardial Infarction - complications; Myocardial Infarction - physiopathology; Myocardial Infarction - psychology; Myocardial Infarction - rehabilitation; Patients; Pilot Projects; Prevention; Quality of life; Quality of Life - psychology; Rehabilitation; Retention; Risk factors; Science; Science (multidisciplinary); Secondary Prevention - methods; Social interactions; Stress; Stress, Psychological - complications; Stress, Psychological - physiopathology; Stress, Psychological - psychology; Stress, Psychological - rehabilitation; Well being
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-019-54932-2

Currently, exercise-based cardiac rehabilitation (CR) is the only recommended secondary prevention strategy for cardiac patients that attempts to tackle stress and psychosocial wellbeing, but it is under-utilized and lacks a comprehensive curriculum for this purpose; hence there is a critical gap to address psychosocial needs of cardiac patients after an event. Mindfulness-based stress reduction (MBSR) has shown benefits in the general population but its role in cardiac patients is not clear. We conducted a pilot randomized controlled trial (RCT) of MBSR in CR-eligible cardiac patients during their initial year of recovery. Patients were allocated 2:1 (intervention:control) to an 8-week MBSR group intervention or usual care. Standard measures of depression, anxiety, perceived stress, health related quality of life (HRQOL), blood pressure, biomarkers (lipids, HbA1c, CRP) and 24-hour Holter monitoring were obtained at baseline, 3- and 9-months post-randomization. Sub-group analyses were performed for participants with at least mild depression (PHQ-9 ≥ 5). 47 patients [mean age 58.6 years; 38% female; 77% white] were enrolled in 2 cohorts. 87% of MBSR patients completed the intervention; study retention was >95% at each follow-up visit. At 3 months, compared to controls, MBSR patients showed improvements in depression [p = 0.01] and anxiety [p = 0.04] with a similar trend in HRQOL [p = 0.06]. The MBSR group showed greater improvement or less worsening of most CV risk factors, with an attenuation of treatment effects at 9 months. Participants with at PHQ-9 scores ≥5 at baseline showed greater improvement in psychosocial and CV outcomes, that persisted at 9 months. MBSR is a safe and well received secondary prevention strategy. This pilot RCT provides preliminary evidence of MBSR’s potential to improve short term psychosocial well-being in cardiac patients during their first year of recovery.