| Summary: | <h4>Background</h4> <p>Although psychological interventions are recommended for the management of coronary heart disease (CHD), there remains considerable uncertainty regarding their effectiveness. </p> <h4>Design</h4> <p>Systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for CHD.</p> <h4>Methods</h4> <p>The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched to April 2016. Retrieved papers, systematic reviews, and trial registries were hand-searched. We included RCTs with at least six months of follow-up, comparing the direct effects of psychological interventions to usual care for patients following myocardial infarction or revascularisation, or with a diagnosis of angina pectoris or CHD defined by angiography. Two authors screened titles for inclusion, extracted data, and assessed risk of bias. Studies were pooled using random effects meta-analysis and meta-regression was used to explore study-level predictors.</p> <h4>Results</h4> <p>35 studies with 10,703 participants (median follow-up 12 months) were included. Psychological interventions led to a reduction in cardiovascular mortality (relative risk 0.79, 95% confidence interval (CI) 0.63 to 0.98), although no effects were observed for total mortality, myocardial infarction, or revascularisation. Psychological interventions improved depressive symptoms (standardised mean difference (SMD) -0.27, 95% CI -0.39 to -0.15), anxiety (SMD -0.24, 95% CI -0.38 to -0.09), and stress (SMD -0.56, 95% CI -0.88 to -0.24) compared with controls.</p> <h4>Conclusions</h4> <p>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 from different presentations of CHD.</p>
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