Positive Implications of Introducing Mindfulness Techniques as a Platform for Preoperative Stress Reduction to Improve Patient Outcomes Postpercutaneous Coronary Intervention

This study[1] aimed to address a critical gap in the preprocedural care for coronary artery disease (CAD) focusing on the often-overlooked psychological aspects of treatment and psychosocial well-being of patients through the use of preoperative meditation and respiratory training to improve patient outcomes postpercutaneous coronary intervention (PCI). Although originally used to prevent relapse in patients with depression, mindfulness is a well-known cognitive behavioral therapy technique with proven efficacy for stress reduction in multiple psychosocial situations. In the preoperative setting, mindfulness has been employed in various surgical arenas with the aim of reducing preoperative anxieties, while simultaneously improving postoperative physical functioning and pain.[1-4] Of the available PubMed-indexed literature, there is a paucity of reports addressing the use of mindfulness in procedural cardiovascular medicine. The authors of this study[1] are the first to extrapolate the use of mindfulness techniques in combination with respiratory training to catheter-based cardiovascular medicine. Their findings now provide valuable insight into the use of a validated technique to improve patient well-being undergoing invasive catheter-based cardiovascular interventions. STUDY DESIGN AND METHODOLOGY The study[1] employed a randomized controlled trial design, enrolling 160 CAD patients, divided into two groups of 80 each. The intervention group received meditation therapies, in the form of 6-min mindfulness videos, breathing therapies conducted 12 times per cycle for three times a day, as well as targeted psychological counseling. The control group received standard care without these interventions. While the study presents a robust design, it is important to note that the nonblinded nature of the trial is a significant limitation that may introduce potential biases in patient responses and outcomes. A thorough assessment of the methodological constraints is crucial for a balanced interpretation of the results. KEY FINDINGS AND CRITICAL EVALUATION The results of this nonblinded randomized controlled trial are particularly noteworthy and of significant relevance for practicing cardiac interventionalists. The findings of the study[1] regarding the implementation of a structured program of meditation and respiratory therapy before PCI led to significant improvements in patient outcomes across multiple domains. Anxiety reduction The intervention group demonstrated significantly lower levels of anxiety as measured by Zung's Self-Rating Anxiety Scale as compared to the control group. This reduction in anxiety is crucial as heightened stress can negatively impact and exacerbate the progression of cardiovascular disease.[4-11] Improved sleep quality The intervention group demonstrated improved sleep quality, as assessed by the Pittsburgh Sleep Quality Index. Better sleep is associated with improved cardiovascular health and may contribute to better recovery post-PCI. However, the study[1] does not fully address the potential confounding factors that could influence sleep quality such as patient variations in medications or other lifestyle changes not otherwise specified in the manuscript that occurred during the study time frame. Cardiovascular parameters This study[1] reported significant reductions in systolic and diastolic blood pressure, as well as heart rate, in the intervention group. These physiologic changes support the potential benefits of mindfulness interventions in procedural medicine. Nonetheless, the lack of blinding in clinical assessments could have introduced bias in these measurements. Procedural outcomes Perhaps most importantly for clinical practice, the intervention group experienced shorter operation times and fewer hospital stays. This finding has implications for both patient comfort and healthcare resource utilization. The clinical significance exhibited by this finding opens the door to discussion for the utilization of preprocedural mindfulness practice to benefit patient outcomes in other surgical and procedural arenas. Significant investigation to assess if the findings of this study[1] hold uniformity in different patient populations and surgical areas of expertise is warranted. Long-term outcomes During the 3-month follow-up period, fewer serious adverse events (SAEs) were observed in the intervention group, including a lower incidence of recurrent angina pectoris and ventricular arrhythmias. While promising, this follow-up period may not be adequately sufficient to fully assess the long-term impact of the intervention group and to comprehensively characterize SAEs that may still occur and potentially result in negative cardiovascular health outcomes. GENERALIZABILITY AND PRACTICAL IMPLICATIONS The study[1] was conducted in a single center with a specific patient population, which limits the generalizability of the findings to diverse patient demographics and healthcare settings. Future research should explore the applicability of these interventions across different populations and healthcare systems. The intervention, consisting of short mindfulness videos and breathing exercises, appears feasible to implement in clinical settings without significant additional resource requirements. This suggests that similar programs could be feasibly incorporated into busy clinical settings. However, the scalability and cost-effectiveness of such interventions across different healthcare systems warrant further exploration. FUTURE RESEARCH DIRECTIONS Larger, multicentered studies with diverse patient populations are needed to validate these findings and assess their generalizability. Longer follow-up periods should be considered to evaluate the sustained impact of mindfulness interventions on cardiovascular health. Future studies should employ blinded designs where possible to strengthen the validity of the findings. More detailed information about participant recruitment, data analysis methods, and potential confounding factors should be included in future research to enhance study transparency. Cost-effectiveness analyses would be beneficial to assess the economic implications and patients' cost burden of implementing these interventions in a variety of healthcare systems that employ different payment structures. CONCLUSION These results underscore the potential of integrating mindfulness-based interventions into standard pre-PCI care protocols. As practicing interventionalists often focus primarily on the technical aspects of procedures and pharmacological management, this study[1] highlights the importance of addressing patients' psychological well-being as an integral part of comprehensive cardiac care. It is also worth noting that the intervention was relatively simple to implement, consisting of short mindfulness videos and breathing exercises. This suggests that similar programs could be feasibly incorporated into busy clinical settings without significant additional resource requirements. While these findings are promising, it must be acknowledged that larger, multicentered studies are needed to validate these results. In addition, future research should explore the long-term impacts of these interventions beyond the 3-month follow-up period utilized. In conclusion, practicing cardiologists should consider the potential benefits of incorporating mindfulness and respiratory therapies into their pre-PCI care protocols. By addressing both the physical and psychological needs of patients, they may be further able to significantly improve both short-term procedural outcomes and enhance long-term cardiovascular health benefits. Author contributions Jeffrey Curran Henson wrote the entirety of the first draft of the manuscript. Kalaivani Sivakumar and Jawahar L. Mehta served as advisors through the drafting and editing process. All authors have given final approval for the current version to be published. Conflicts of interest Dr. Jawahar L. Mehta is an Associate Editor-in-Chief of Heart and Mind. The article was subject to the journal's standard procedures, with peer review handled independently of Dr. Jawahar L. Mehta and the research groups. There are no conflicts of interest.