The Influence of eHealth Stress Management Interventions on Psychological Health Parameters in Patients With Cardiovascular Disease: Systematic Review and Meta-Analysis

Background: Chronic stress is a critical factor influencing both physical and mental health. It can weaken the immune system, affect cardiovascular health, and lower quality of life, often leading to psychological disorders like anxiety and depression. Objective: This study aims to evaluate the effectiveness of eHealth stress management interventions on psychological health parameters, specifically anxiety, depression, stress, and quality of life in patients with cardiovascular disease (CVD). Methods: A comprehensive search was conducted across several databases, including the Cochrane Library, APA PsycInfo, Web of Science, PubMed, Embase, and clinical trial registers. Randomized controlled trials assessing the impact of eHealth stress management interventions, namely internet-based cognitive behavioral therapy (CBT), telephone-delivered CBT, internet-based stress management training, or telephone-delivered stress management training, on the specified psychological outcomes in patients with CVD were included. The control group comprised no intervention, a waitlist, (enhanced) usual care, or a web-based intervention not focusing on stress management. To evaluate potential bias, the Risk-of-Bias 2 tool was applied. A random-effects meta-analysis was performed using standard mean difference (SMD) as the effect size, with a sensitivity analysis using mean difference (MD). Results: A total of 6 randomized controlled studies were considered in the meta-analysis. In 5 studies internet-based CBT interventions were examined, while one study used an eHealth intervention based on a CBT approach. The control groups received either usual care, were placed on a waitlist, or participated in a web-based discussion forum. After the intervention period, which ranged from 8 weeks to 6 months, a significant reduction in depressive symptoms (SMD=-0.46, MD=-2.33; P<.001), as assessed by the Patient Health Questionnaire-9, was observed in the intervention group compared with the control group. Mental health-related quality of life, assessed by the subscale of the 12-Item Short-Form Health Survey, showed significant improvement (SMD=0.38, MD=3.89; P<.001) in the intervention group in comparison to the control group following the intervention period. Conclusions: The meta-analysis demonstrates that eHealth stress management interventions substantially improve psychological health parameters in patients with CVD. Given the significant positive impact, health care providers should consider integrating eHealth stress management programs into standard care for patients with CVD. These programs can be a valuable tool in mitigating the psychological burdens associated with chronic cardiovascular conditions, ultimately improving overall patient outcomes and quality of life. Trial Registration: PROSPERO CRD42024495179; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024495179