Face-to-Face and Internet-based Cognitive Behavioral Therapy for Patients with Heart Failure: an Umbrella Review of Systematic Reviews and Meta-analyses
Clinical Snapshot
PICO Framework
| P — Population | Patients with heart failure aged 51.63 to 77.40 years from USA, Sweden, Netherlands, China, Iran, and Philippines |
| I — Intervention | Face-to-face and internet-based cognitive behavioral therapy (CBT and iCBT) |
| C — Comparator | Standard care or control interventions (as defined in included meta-analyses) |
| O — Outcomes | Depressive symptoms, quality of life, anxiety symptoms, self-care, 6-minute walk distance, and health status |
Bottom Line
This umbrella review synthesizes evidence from five meta-analyses examining CBT effectiveness in heart failure patients. While CBT shows promise for improving depressive symptoms (89% of studies), quality of life (56%), and anxiety (39%), the evidence quality is limited by methodological inconsistencies and lack of pooled effect size analyses. The review identifies significant research gaps, particularly for internet-based CBT, and calls for individual participant data meta-analyses with meta-regression. Clinicians should consider CBT as an adjunctive treatment for heart failure patients with psychological comorbidities, but implementation should be guided by individual patient factors and local service availability. The evidence base would benefit from more rigorous primary studies, especially focusing on iCBT delivery models and standardized outcome measurements across different follow-up timepoints.
Key Findings
P Value: Not reported
Effect Size: Not reported - only proportions of studies showing benefits provided
Primary Outcome: Depressive symptoms showed improvement in 89% of studies
Nnt Or Sensitivity: Quality of life improved in 56% of studies, anxiety in 39%, self-care in 33%
Confidence Interval: Not reported
Clinical Application
Both face-to-face and internet-based delivery modes appear feasible, though iCBT requires more research Relevant to Australian cardiology and mental health services; aligns with RACGP guidelines for integrated care; potential PBS implications for psychological services in chronic disease management Heart failure patients aged 50-80 years suitable for psychological interventions
Abstract
PURPOSE OF REVIEW: The present study aims to provide an up-to-date umbrella review of existing meta-analyses of randomized control trials (RCT) of cognitive behavioral therapy (CBT) among patients with heart failure (HF). RECENT FINDINGS: The umbrella review covered five meta-analyses published in the past five years with 18 primary studies (conducted between 2010 and 2022) of 1,687 non-duplicated patients aged 51.63 to 77.40. Primary studies originated from the USA, Sweden, Netherlands, China, Iran, and Philippines. Common benefits of CBT included depressive symptoms (89%), quality of life (56%), anxiety symptoms (39%), self-care (33%), 6-minute walk distance (33%), and health status (17%). Evidence varied depending on the timepoint of follow-up assessment and the specific measurement used to evaluate the outcome. No meta-analyses pooled the effect sizes for iCBT and analyzed the specific therapeutic elements in CBT. No meta-regression was performed. Individual participant data meta-analyses with meta-regression should be performed to identify common moderators and factors that can influence treatment adherence. The current research would also benefit from additional RCT evidence focusing specifically on iCBT for patients with HF.
References
- 1.Liu, H., Peng, Z., & Hou, W. K. (2026). Face-to-Face and Internet-based Cognitive Behavioral Therapy for Patients with Heart Failure: an Umbrella Review of Systematic Reviews and Meta-analyses. Current Heart Failure Reports. https://doi.org/10.1093/eurjcn/zvad097
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