Abstract
People with coronary heart disease (CHD) often suffer from severe distress. This stress is likely to stimulate the sympathetic system resulting in increased heart rate, respiratory rate, blood pressure, myocardial oxygen demand and anxiety levels. Such adverse effects put the cardiac patient at greater risk for complications, including sudden cardiac death. Therefore, it is of crucial importance that in the care of patients with CHD offer stress-reducing interventions. One feature of such an intervention can be music, an intervention that can help patients focus their awareness on the music, to promote relaxation [1]. Music intervention is a nursing intervention to facilitate healing through pre-recorded music, defined as “a supportive source of environmental sound that stimulates and maintains relaxation and reduces or controls distress by a self-management technique” [2]. The use of listening to pre-recorded music has also been defined as “Music medicine” in contradiction to “Music therapy” that includes an in-person music therapy treatment by a music therapist [3]. Music that has this relaxing and stress-reducing effect includes a slow and flowing tempo around 60–80 beats per minute, a maximum level of 60 dB and with duration of 20–60 min [2]. Yet, no clear picture has emerged regarding which genre is superior, or if research selected versus patient-selected music is most beneficial [1–3]. The mechanism behind the effect of relaxing music is not clearly understood. It has been reported that the relaxing effect of music is related to an increased release of plasma oxytocin [4], and a reduction in plasma cytokine and catecholamine levels [5]. These responses to music convey emotions through autonomic arousal, likely in a bidirectional way [6]. A strong positive correlation exists between the pleasurable aspects of music listening and emotional arousal [7].
Florence Nightingale proposed that it was the responsibility of nursing to control the patient's environment in order for healing to take place. She recognized the power of music as a part of the healing process. She recommended wind instrumental pieces with continuous sound or air as generally having a beneficial effect on the sick. She also observed that instruments, which do not produce continuous sounds, would have the opposite effect [2]. A recent Cochrane review [8] indicates that music listening can have a beneficial effect for people suffering from CHD though music listening reduce anxiety in myocardial infarction patients upon hospitalisation as well as reduce systolic and diastolic blood pressure and heart rate. The review therefore recommends that music listening be offered as a stress management intervention to MI patients upon hospitalisation. This blood pressure reduction effect of music has also been reported in a recent study in older adults [9].
There is no clear evidence showing that soothing music has a positive effect on patients during coronary angiographic procedures [1,8]. This may be due to the fact that anxiety is measured after completion of the procedure rather than during. Physiological data indicates, however, that patients may experience less anxiety during the procedure when listening to music [8]. Both patients and staff alike look favorably on music listening and the delivery of it during the procedures do not disturb the examination [1]. Since physiological responses are continuously monitored during procedures with CHD patients, and music interventions can be easily halted in case the patient does not experience beneficial effects, it is recommended that music listening is offered as an anxiety management intervention prior to and during procedures [1,8].
Studies reporting gender differences in response to different music stimuli are rare. Only one study on gender differences in response to music interventions in clinical settings has been found reporting no differences between gender [1]. Gender differences in response to music interventions need further study. Particularly though women with CAD suffer from more anxiety [1,10] as well as more disturbed sleep [10].
Besides gender differences, more information is needed about optimal length, the timing and the effect of multiple sessions of the music intervention. Can music increase sleep quality also for MI patients, especially women, as it has been reported in older adults [11]. For patients during coronary angiographic procedures, what is the most effective time to start the music intervention? Should the music intervention continue after completion of the procedure, and if so, for how long?
In conclusion, providing music is an inexpensive technique, which does not require the use of extra manpower and resources. Music intervention can maximize the effort of promoting comfort and relaxation, as well as reduce or control distress. For that reason, music is a nursing intervention that has an obvious role in cardiac care.