Mythbusting

Stress reductions might *actually* save a heart attack.

It is entirely possible that in 10 years, as part of a post cardiac admission, you will be included in small group therapy sessions.

Based on this study, 151 outpatients with coronary artery disease were randomized to 12 weeks of cardiac rehab or cardiac rehab (75 patients)+ stress management training (76 patients). Stress management training consisted of 12 weekly 1.5 hour sessions of 4-8 participants.

Per the authors: “Emphasis is placed on the importance of cognitive appraisals in affecting stress responses, with recognition of irrational beliefs and cognitive distortions such as overgeneralization, catastrophizing, and all-or-nothing thinking. Later sessions focus on the importance of effective communication, including topics of assertiveness and anger management. Instruction in problem-solving strategies is also provided in which participants are encouraged to apply the skills that they have learned to address everyday problems. Methods included brief lectures, group discussion, role playing, instruction in specific behavioral skills, and weekly homework assignments.”

Patients who received stress management experienced improvements in anxiety, distress, & perceived stress. Patients were followed for a median of 3 years for “clinical events” defined as death, MI, stent/CABG, stroke/TIA, angina requiring hospitalization) , with a rates of 47%, 33% vs 18% for no rehab/stress management, rehab only, and rehab + stress management.

Yes, the trial is small. Yes it is a composite outcome.

But the NNT for cardiac rehab vs none is 7.1… The NNT for stress management in addition to rehab is 6.7, for both stress management and cardiac rehab the NNT is 3.4.

So, doing some back of the envelope calculations, what would these meetings cost insurance companies? $200 a session? At 12 sessions ($2400), with an NNT of about 7, I get about $16,800 to save one adverse outcome. I think that actually works out well in everyone’s favor. Perhaps this is something we’ll see in the future.

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