Women’s participation in stress management interventions for chronic heart failure: a meta-analysis of randomized controlled trials

ABSTRACT

Stress management interventions (SMIs) can alleviate the psychosocial stress often experienced by women with heart failure. The purpose of this meta-analysis was to summarize women’s participation rates, and predictors of participation, in SMIs for the management of psychosocial distress in women with chronic HF. Studies were retrieved from bibliographic databases, reference sections of relevant papers, and research registries. Included studies (a) evaluated a SMI approach for the management of chronic HF, (b) sampled chronic HF patients, and (c) used a randomized controlled trial (RCT) design. Independent coders extracted the relevant data. Thirty-five RCTs met inclusion criteria (N = 3,649; mean age = 63.5 ± 7.0 years). All studies sampled both men and women; the mean proportion of women who participated in the trials was 38.8% (95% confidence interval [CI] = 34.5–43.4; I² = 82.4, 95% CI = 81.0–83.6). Women’s participation rates were higher in studies sampling more HF patients with hypertension (B = 1.01, SE = 0.45, P = .046) but fewer HF patients prescribed beta blockers (B = −1.10, SE = 0.33, P = .006), F (2,12) = 6.27, P = 0.014, adjusted R² = 61%. SMIs may offer women a complementary or integrative approach to standard treatment to help manage the psychological distress associated with HF. Future research should explore the potential benefits of offering stress management approaches to women as part of comprehensive HF care.

KEYWORDS:

• Chronic heart failure
• women
• stress management interventions
• meta-analysis

Acknowledgments

We are grateful to the Systematic Review and Meta-Analysis Research Methods (SMART) Team, especially Julie DeCosta, Marissa L. Donahue, Melissa M. Feulner, and Brittany L. Balletto, for their assistance with data collection.

Availability of data and material

The data used in this meta-analytic review were extracted from published randomized controlled trials of stress management interventions for heart failure patients. The database used to conduct the analyses is available upon request to the first author.

Code availability

The commands used to conduct the meta-analysis are available in Stata 16.0.

Disclosure statement

The authors declare that they have no conflicts of interest.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health under award number [5R01AT008815] to Lori A. J. Scott-Sheldon, PhD. Emily C. Gathright, PhD is supported by [5K23AG061214] from the National Institute on Aging. Elena Salmoirago-Blotcher is supported by grant [5R01HL149672] from the National Heart, Lung and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health;National Center for Complementary and Integrative Health [5R01AT008815];National Institute on Aging [1K23AG061214]; National Heart, Lung, and Blood Institute [5R01HL149672]