Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Apr 7:27:e57368.
doi: 10.2196/57368.

Psychological eHealth Interventions for Patients With Cardiovascular Diseases: Systematic Review and Meta-Analysis

Jing Jing Su  1   2 , Rose Lin  3 , Ladislav Batalik  4   5 , Arkers Kwan Ching Wong  6 , Sherry L Grace  7   8   9
Affiliations
Meta-Analysis

Psychological eHealth Interventions for Patients With Cardiovascular Diseases: Systematic Review and Meta-Analysis

Jing Jing Su et al. J Med Internet Res. .

Abstract

Background: Psychological distress is recognized as an independent risk factor for cardiovascular diseases (CVDs), contributing to increased morbidity and mortality. While eHealth is increasingly used to deliver psychological interventions, their effectiveness for patients with CVDs remains unclear.

Objective: This meta-analysis aimed to evaluate the effects of eHealth psychological interventions for patients with CVDs.

Methods: Eligible studies were retrieved from 5 databases (Embase, Medline, PubMed, CINAHL, and Cochrane Library), covering the period from database inception to December 2024. Randomized controlled trials (RCTs) investigating the effect of evidence-based psychological eHealth interventions to improve psychosocial well-being and cardiovascular outcomes for people with CVDs were included. The Cochrane Risk of Bias tool (version 2) was used to judge the methodological quality of reviewed studies. RevMan (version 5.3) was used for meta-analysis.

Results: A total of 12 RCTs, comprising 2319 participants from 10 countries, were included in the review. The results demonstrated significant alleviation of depressive symptoms for patients receiving psychological eHealth intervention compared to controls (number of paper included in that particular analysis, n=7; standardized mean difference=-0.30, 95% CI -0.47 to -0.14; I2=57%; P<.001). More specifically, in 6 trials where internet-based cognitive behavioral therapy was delivered, a significant alleviation of depressive symptoms was achieved (standardized mean difference=-0.39, 95% CI -0.56 to -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: Psychological eHealth interventions, particularly internet-based cognitive behavioral therapy, can significantly reduce depressive symptoms among patients with CVDs. A multidisciplinary approach is crucial for comprehensively improving psychological and cardiovascular outcomes. Future studies should explore integrating persuasive design features into eHealth and involving mental health professionals for intervention delivery.

Trial registration: PROSPERO CRD42023452276; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023452276.

Keywords: CBT; CVD; Cochrane Risk of Bias Tool; GRADE approach; anxiety; cardiology; cardiovascular diseases; cognitive behavioral therapy; depression; digital health; eHealth; evidence-based; heart; high-risk; iCBT; internet-based; mental health; meta-analysis; psychological; psychological intervention; psychological therapy; psychosocial; psychotherapy; systematic review.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. RCT: randomized controlled trial.
Figure 2
Figure 2
Risk of bias assessment [24,31,33-42].
Figure 3
Figure 3
Forest plot showing the efficacy of eHealth psychological interventions for depression.
Figure 4
Figure 4
Forest plot showing the efficacy of eHealth psychological interventions for anxiety.
Figure 5
Figure 5
Forest plot showing the efficacy of eHealth-based psychological interventions for health-related quality of life.
See this image and copyright information in PMC

References

    1. Ma Li-Chao, Liu Juan, Jiao Cui-Liu, Du Shao-Ying, Zhang Ruo-Lan, Ding Xiao-Juan, Shi Xiao-Yang, Wang Yan. Exploring the effects of an online learning platform in stage III cardiac rehabilitation for individuals with coronary heart disease: Randomized controlled study. Medicine (Baltimore) 2024 Sep 13;103(37):e39497. doi: 10.1097/MD.0000000000039497. https://doi.org/10.1097/MD.0000000000039497 00005792-202409130-00087 - DOI - DOI - PMC - PubMed
    1. Yuan M, Fang Q, Liu G, Zhou M, Wu J, Pu C. Risk factors for post-acute coronary syndrome depression: a meta-analysis of observational studies. J Cardiovasc Nurs. 2019;34(1):60–70. doi: 10.1097/JCN.0000000000000520. - DOI - PubMed
    1. Chen Ying-Ying, Xu Ping, Wang Yuan, Song Tian-Jiao, Luo Nan, Zhao Li-Jing. Prevalence of and risk factors for anxiety after coronary heart disease: systematic review and meta-analysis. Medicine (Baltimore) 2019 Sep;98(38):e16973. doi: 10.1097/MD.0000000000016973. https://europepmc.org/abstract/MED/31567932 00005792-201909200-00002 - DOI - PMC - PubMed
    1. Li G, Tian Y, Zhang Q, Jin Z, Song Y. The predictive effect of negative psychological emotions of anxiety and depression on the poor prognosis of chd patients with stent implantation and the improvement of clinical intervention measures. Comput Math Methods Med. 2022;2022:2534277. doi: 10.1155/2022/2534277. https://doi.org/10.1155/2022/2534277 - DOI - DOI - PMC - PubMed
    1. Grace Sherry L, Gallagher Jonathan, Tulloch Heather. The psychological component of cardiac rehabilitation drives benefits achieved. Eur J Prev Cardiol. 2022 Mar 25;29(3):e141–e142. doi: 10.1093/eurjpc/zwab040.6272963 - DOI - PubMed

MeSH terms

LinkOut - more resources