Effects of non-pharmacological interventions on anxiety or depressive symptoms in patients with heart failure: A systematic review and network meta-analysis

OBJECTIVE Anxiety and depression are common psychological symptoms following heart failure (HF) and are associated with adverse patient outcomes. However, pharmacological treatments often have suboptimal efficacy. Recently, non-pharmacological interventions have attracted increasing attention for improving psychological symptoms in HF patients, yet the most effective approach remains unclear. Therefore, this study performed a network meta-analysis (NMA) to compare the effectiveness of different non-pharmacological interventions in alleviating anxiety or depression among HF patients. METHODS We comprehensively searched PubMed, Embase, the Cochrane Library, and PsycINFO from inception to March 2025 to identify randomized controlled trials (RCTs) evaluating non-pharmacological interventions for anxiety or depression in HF patients. The RoB 2.0 tool was employed to assess methodological quality and risk of bias. An NMA was conducted under a frequentist framework using R and Stata software. Intervention efficacy was ranked using P-scores, and sensitivity analyses were performed to evaluate the stability of the results and explore potential sources of heterogeneity. RESULTS A total of 35 RCTs and one quasi-RCT involving 3829 participants were included. NMA results indicated that Tai Chi (P-score = 0.73; standardized mean difference (95% CI):-0.69(-1.59 to 0.21)) was the most efficacious intervention for improving anxiety symptoms in HF patients, while progressive muscle relaxation training (P-score = 0.78;-1.24(-2.74 to 0.26)) ranked highest for improving depressive symptoms. However, only aerobic exercise demonstrated statistically significant improvements in both anxiety (P-score = 0.63; -0.47(-0.86 to -0.07)) and depression (P-score = 0.74; -0.93(-1.44 to -0.41)). CONCLUSION Aerobic exercise appears effective for both anxiety and depression following HF. However, the evidence is of low to very low certainty.