Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 14, 2024
Open Peer Review Period: Feb 14, 2024 - Apr 10, 2024
Date Accepted: Mar 14, 2025
(closed for review but you can still tweet)
eHealth Psychological Interventions for Patients with Cardiovascular Diseases: A Systematic Review and Meta-analysis
ABSTRACT
Background:
Psychological disorders are recognized as independent risk factors for cardiovascular diseases (CVDs), contributing to increased morbidity and mortality. While eHealth is increasingly used to deliver psychological interventions, their effectiveness for patients with or at high-risk of CVDs remains unclear.
Objective:
This meta-analysis aimed to evaluate the effects of eHealth psychological interventions for patients with or at high-risk of CVDs.
Methods:
Eligible studies were retrieved from five databases, covering the period from inception to Sep 2023. Randomized controlled trials (RCTs) investigating the effect of evidence-based eHealth psychological intervention to improve psychosocial wellbeing and cardiovascular outcomes for people with or at high-risk of CVDs were included. Cochrane Risk‐of‐Bias Assessment Tool V2 was used to judge the methodological quality of reviewed studies. RevMan 5.3 was used for meta-analysis. Quality of evidence was assessed using the GRADE approach.
Results:
A total of 12 RCTs, including 2,319 participants from 10 countries were included in the review. The results demonstrated significant alleviation of depression for participants receiving eHealth psychological intervention compared to controls [n=7, SMD=-0.30, 95% CI (-0.47, -0.14), I2=57%, P < .001]. More specifically, in six trials where Internet-based cognitive behavior therapy was delivered a significant alleviation of depression was achieved [SMD=-0.39, 95% CI (-0.56, -0.21), I2=53%, P <.001]. There was no significant change in anxiety or quality of life. Synthesis without meta-analysis regarding stress, adverse events and cardiovascular events showed inconclusive findings.
Conclusions:
eHealth psychological interventions, particularly internet-based cognitive behavioral therapy, can significantly reduce depressive symptoms among patients with or at high-risk of CVDs. A multi-disciplinary approach is crucial for comprehensively improving psychological and cardiovascular outcomes. Future research should explore integrating persuasive design elements into eHealth and involving mental healthcare professionals to support and guide intervention delivery. Clinical Trial: CRD42023452276
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