Effectiveness of Acceptance and Commitment Therapy on self-care, psychological symptoms, and quality of life in patients with cardiovascular disease: A systematic review and meta-analysis

Background: Cardiovascular diseases (CVDs) remain a public health problem. Patients with CVDs face difficulties adhering to self-care recommendations and experience psychological symptoms and impaired quality of life (QOL). The benefits of acceptance and commitment therapy (ACT) have been demonstrated in these health outcomes but have yet to be for CVD patients. The purpose of this study was to review the evidence to determine the effects of ACT on such health outcomes in CVD patients using narrative and quantitative approaches. Methods: Experimental studies using ACT interventions in adult patients with CVDs on QOL, self-care, and psychological symptoms were identified. Studies published in English and Chinese in ten major databases with no time limits until November 2022 were considered. The risk of bias was evaluated using the assessment tool of the Effective Public Health Practice Project (EPHPP) and the Psychotherapy Outcome Study Methodology Rating Form (POMRF). Meta-analyses were performed on clinically homogeneous comparisons where possible. Results: A total of 17 experimental studies with 1,312 participants were included. Despite the heterogeneity of the studies, the findings showed that ACT interventions tend to improve QOL and self-care in CVD patients. The pooled results also indicated that the effects of ACT interventions on anxiety as measured by the Generalized Anxiety Disorder (GAD-7) Scale significantly outperformed those of comparator groups (combined MD −1.54, 95% CI −2.14 to −0.95) at post-treatment for CVD patients, as well as on depression as measured using the Patient Health Questionnaire (PHQ-9) (combined MD −2.46, 95% CI −3.61 to −1.31). Conclusions: ACT appears to be effective at improving health outcomes in patients with CVD. Due to the high heterogeneity of the reviewed studies and the lack of transparent reporting on the form and intensity of ACT interventions for patients with CVD, only a small number of studies were included in the current meta-analysis, which may partially threaten the reliability and reproducibility of the findings. Recommendations and future research directions are provided to optimize future research on ACT interventions for patients with CVD.