Complementary Alternative Cardiovascular Medicine

Chapter 9 /Prayer and CVD 145
receiving noetic interventions, although these differences had wide confidence
intervals and were not statistically significant. The greatest
magnitude of absolute reduction in MACE was seen in the patients who
were treated with prayer.
The MANTRA Pilot studied the most homogeneous group of patients
among these reported cardiac randomized trials, with a focus on patients
with acute coronary disease undergoing invasive catheter-based procedures.
In addition to this more focused patient cohort, the study systematically
followed nonstudy related patient, family, and chaplain prayer
said before the angioplasty, reporting the presence of chaplain and/or
family in the room in 66% of patients and the awareness of nonprotocol
prayer by patients on their own behalf in just fewer than 50% of the
patients in the control group.
The MANTRA Pilot study design was also unique for its “high-dose”
prayer model. In the Byrd, Harris, and Aviles studies, between one and
six intercessors were used for each patient, and all intercessors were
Christians. In the MANTRA Pilot, every patient randomized to the prayer
therapy treatment assignment had his or her name, age, and illness sent
to nine congregations of intercessors, including several Christian, Jewish,
and Buddhist denominations, who all prayed on each patient’s behalf.
Although not statistically significant in the small pilot population studied,
the absolute reduction in complication rates of standard clinical endpoints
represents one of the largest apparent treatment effects reported
over the four published randomized cardiology trials.
AMERICAN COLLEGE OF CARDIOLOGY
CONSENSUS STATEMENT
The American College of Cardiology (ACC) is currently preparing a
consensus statement on CAM, which includes a section on spirituality
(14). This consensus document states that given the current literature, no
recommendations can be made regarding the application of spiritual
therapy in cardiovascular medical practice. It also recommends that for
the purpose of clinical studies, spirituality must be considered an investigational
therapeutic agent, like any other, and that safety and efficacy
trials must be conducted with full informed consent for patients. The
document recommends the development of a common nomenclature for
terms and standardized measures for outcomes in terms of these trials
and suggests that endpoints should go beyond morbidity and mortality
to include quality of life, end-of-life care issues, and cost effectiveness.
That the ACC has accepted to create such a consensus document adds
validity to the need for further investigation in this area.