Stress Management Interventions for Adults With Heart Failure: Systematic Review and Meta-Analysis

Objective: Stress management interventions (SMIs) targeting psychological stress and other psychosocial factors associated with heart failure (HF) morbidity and mortality are increasingly recommended for adults with HF. SMI content and delivery varies widely and meta-analyses are needed to synthesize current findings to identify gaps in the literature. The purpose of this meta-analysis is to examine the efficacy of SMIs for improving anxiety, depressive symptoms, exercise capacity, and disease-specific quality of life in adults with HF. Method: Comprehensive searches of 10 electronic bibliographic databases identified peer-reviewed, published, randomized controlled trials (RCTs) of SMIs for adults with HF. Results: Twenty-three RCTs were included (N = 2,294; M-age = 63.09 +/- 7.27 years; 40% women, 56% White). Pooled effects indicated greater improvements in anxiety (d+ = .49, 95% confidence interval [CI] = [.09-.89], k = 10), depressive symptoms (d+ = .39, 95% CI [.03, .75], k = 13), disease-specific quality of life (d+ = .82, 95% CI [.40, 1.24], k = 16), and exercise capacity (d+ = .57, 95% CI [.20, .95], k = 14) among SMI recipients relative to controls at the first postintervention assessment. The benefits were not maintained at follow-up. Participant characteristics (e.g., proportion women, HF severity), but not intervention type, moderated the findings. Conclusions: SMIs for adults with HF demonstrated short-term improvements in anxiety, depressive symptoms, quality of life, and exercise capacity. Future research sampling patients who are psychologically distressed with more thorough assessment of stress and longer follow-ups can elucidate the benefits of SMIs among adults with HF.