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Pre-CABG optimization of patient expectations improves outcomes
Optimizing patients’ expectations before CABG improved outcomes and quality of life 6 months after surgery, according to new data.
“Placebo mechanisms contribute substantially to clinical treatments in various fields of medicine, but systematic approaches to utilize these mechanisms for improved outcome are scarce,” Winfried Rief, PhD, of the division of clinical psychology at the University of Marburg in Germany, and colleagues wrote. “While placebo effects are substantial for patient-reported outcomes such as pain or depression, placebo effects can be also demonstrated for objective parameters such as immune responses, [CV] parameters, dopamine release, electroencephalogram and functional [MRI] parameters.”
Rief and colleagues studied 124 patients scheduled for CABG from April 2011 to May 2015. Participants were randomly assigned to one of two presurgery psychological interventions or standard medical care (SMC). The first intervention (EXPECT) focused on the development of realistic expectations and plans for the recovery process. The second intervention (SUPPORT) did not focus on expectations, but on expressing emotions and anxieties about the surgery. Both intervention groups received the same amount of therapist attention.
The primary outcome was a disability score, assessed by the pain disability index, which includes ratings in seven areas of life. Quality of life, fitness for work, physical activity, cardiac anxiety and mental health were also assessed at 6-month follow-up.
Improvements in disability
For patients in the EXPECT group, improvements in disability were significantly larger (–12.6; 95% CI, –17.6 to –7.5) vs. the SMC group (–1.9; 95% CI, –6.6 to 2.7) and the SUPPORT group (–6.7; 95% CI, –11.8 to 1.7), the researchers wrote.
Disability from baseline to follow-up decreased in the EXPECT group (P < .001) and the SUPPORT group (P = .01) but not the SMC group (P = .404), according to the researchers. EXPECT was superior to SMC for the primary outcome (P = .003) but SUPPORT was not (P = .186), and there was a trend in favor of EXPECT over SUPPORT (P = .095), Rief and colleagues wrote.
Mental quality of life and ability to work was significantly improved for participants in the EXPECT group vs. the SUPPORT and SMC control arms. Physical quality of life improved significantly for both psychological intervention arms compared with the SMC group. Depression and general anxiety decreased between admission and follow-up across all three groups.
Both the EXPECT and SUPPORT groups had less pronounced increases in pro-inflammatory cytokine concentrations at follow-up vs. the SMC group. Additionally, the EXPECT group had lower interleukin-6 levels.
No adverse effects were associated with the psychological interventions.
Personalized support
“Patients who received any level of psychological support prior to surgery were better off 6 months after surgery,” Rief said in a press release. “Personalizing the patients’ support by offering specific guidance on how they can achieve a faster, better recovery appeared to have the greatest benefit. Doctors should assess their patient’s expectations individually to work out what level of support would be most useful. Our study also shows that a short-term psychological intervention is feasible and can be implemented easily into a cardiac surgery unit. There is also potential for cost savings as patients end up spending less time in the hospital.” – by Cassie Homer
Disclosure: Rief reports receiving honoraria from Bayer, Berlin Chemis and Heel. Please see the full study for the other researchers’ relevant financial disclosures.