DURHAM, N.C. -- Not only does stress management appear to reduce the long-term chances of heart patients having another cardiac event, but a new analysis by Duke University Medical Center researchers and the American Psychological Association demonstrates that this approach also provides an immediate and significant cost savings.
In terms of both financial costs and reducing cardiac events, moreover, the benefits of stress management seem to exceed those of both exercise and usual heart care.
The team found a financial benefit of stress management strategies within the first year of the study. Average costs for patients who utilized stress management were $1,228 per patient during the first year, as compared to $2,352 per patient for those who exercised and $4,523 per patient for those who received usual care.
Moreover, the researchers found, the financial benefit of stress management was maintained over time. Average costs rose only to $9,251 per patient during the fifth year for those who used stress management strategies, compared to $15,688 per patient for those who exercised and $14,997 per patient for those who received usual care. Average costs per patient per year during the five years were $5,998 for those who used stress management, $8,689 for those who exercised and $10,338 for those who received usual care.
The medical outcomes also were notable. Patients in both the "exercise group" and the "usual care group" averaged 1.3 cardiac events – bypass surgery, angioplasty, heart attack or death – by the fifth year of follow-up. Those in the "stress management group," by contrast, averaged only 0.8 such events during the same period.
"These results extend our earlier work that showed stress management programs reduce cardiac events in the short term, and now we can demonstrate a long-term benefit," said Duke psychologist James Blumenthal, who led the study. "While confirming the long-term medical benefit of a stress management program for heart patients, the results of this analysis demonstrate a significant financial benefit as well."
The results were published in the Jan. 15, 2002 issue of the American Journal of Cardiology. The study was supported by three grants from the National Institutes of Health.
In the study, 94 male patients with established coronary artery disease were assigned to one of three groups. The first group received 1.5 hours per week of stress management training for 16 weeks, the second group exercised three times per week during a four-month period and the third received usual and traditional care. The researchers then conducted follow-up on the patients annually for five years.
"While we were not surprised by the overall beneficial effects of stress management, we were surprised and pleased that the effects accrued so rapidly," said Russ Newman, executive director for professional development at the American Psychological Association (http://www.apa.org).
"The economic portion of this analysis is very important," Newman continued. "While the medical literature supports the long-term economic benefits of psychological interventions, this study shows an immediate and sustainable cost saving. These findings help us immeasurably in making the case to health care systems and employers that psychological approaches can help their members at risk for cardiovascular disease."
Stress management programs begin by helping patients identify the physical, behavioral, emotional and cognitive symptoms of stress. Patients then are taught how to react realistically and positively to these stresses. "One of the benefits of a stress management program is that once you've learned how to recognize and handle the stresses of everyday life, it tends to stay with you," Blumenthal said. "This is unlike exercise, which must be maintained for the benefits to be realized."
While he does not know why the benefits of exercise seemed to diminish over time, Blumenthal speculates that the "exercise group" may not have kept up with their exercise with the same frequency or intensity as the original four-month period. Psychologist Geoffrey Reed, co-author on the paper and assistant executive director for professional development at the APA, whose work on behalf of the APA includes demonstrating to health care delivery systems the value of psychological approaches to treating disease, believes the results of this study gives him added ammunition.
"In general, psychosocial approaches are not taken into account enough by the medical community," Reed said. "Cardiologists have been fairly accepting as a group because the link between behavior and cardiovascular events is more obvious, but outside of cardiology, the medical establishment continues to underestimate the importance of psychological factors in the disease process."
For their economic analysis, the team used data supplied by the U.S. Public Health Service Panel on Cost-Effectiveness in Health and Medicine, which uses national averages in determining the costs of different procedures and events.
Other Duke members of the teams included Michael Babyak, Dr. Wei Jiang, Dr. Christopher O'Connor, Dr. Robert Waugh, Eric Eisenstein, Dr. Daniel Mark and Andrew Sherwood. Other members of the team were Pamela Woodley and Richard Irwin, both from the accounting firm of Pricewaterhouse Coopers, who conducted the financial analysis.
Note to editors: James Blumenthal can be reached at 919-684-3828 or blume003@mc.duke.edu
A color photograph of Blumenthal is available at http://www.dukemednews.duke.edu/gallery/detail.php?id=226
Press contact for the American Psychological Association is Luana Bossolo, 202-336-5899 or lbossolo@apa.org.