Effects of Five-Element Music Therapy Combined with Relaxation Therapy on the Recovery of Elderly Patients with Unstable Angina Pectoris Following Percutaneous Coronary Intervention

Abstract

Background:

Unstable angina pectoris (UAP) is prevalent among the elderly, and it is often treated with percutaneous coronary intervention (PCI). This study assessed the effect of five-element music therapy (FEMT) combined with relaxation therapy (RT) on recovery outcomes in elderly patients with UAP after PCI.

Methods:

This retrospective cohort study included 287 elderly patients with UAP (age > 60 years) treated by PCI at Wenzhou Yining Geriatric Hospital between April 2021 and April 2023. Patients were divided into two groups: the RT group (n = 132) and the FEMT combined with RT (FEMRT) group (n = 155). Baseline characteristics, therapeutic effects, anxiety level (Self-Rating Anxiety Scale [SAS], quality of life (Seattle Angina Questionnaire [SAQ], echocardiographic parameters, and serum biomarkers were evaluated.

Results:

The FEMRT group exhibited significant improvements in therapeutic effects compared with the RT group (P = 0.032), with notable increases in patients experiencing significant therapeutic effects (38.06% vs. 27.27%). Post-intervention, the SAS score decreased more in the FEMRT group than in the RT group (P = 0.006). SAQ results indicated enhanced quality of life and treatment satisfaction in the FEMRT group (P < 0.01). Both groups exhibited improvements in echocardiographic parameters (including stroke volume, left ventricular ejection fraction, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter) and serum biomarkers (including tumour necrosis factor-alpha, interleukin-6, and N-terminal pro-brain natriuretic peptide), but the differences between the groups were not significant.

Conclusion:

The integration of FEMRT significantly enhanced recovery post-PCI in elderly patients with UAP, as evidenced by improved clinical and quality of life outcomes.

KEY MESSAGES

• (1)Combining five-element music therapy with relaxation therapy (FEMRT) significantly improved treatment outcomes versus relaxation therapy alone (RT), with higher rates of symptom reduction and ECG normalization.
• (2)FEMRT substantially reduced anxiety and improved quality of life, including fewer physical limitations, greater angina stability, and higher treatment satisfaction.
• (3)Both groups showed comparable improvements in cardiac function parameters and serum biomarkers, indicating no added physiological advantage from FEMRT.

INTRODUCTION

Unstable angina pectoris (UAP) remains a critical and prevalent cardiovascular condition among elderly populations. Unlike stable angina, UAP is characterised by unpredictable episodes of chest pain that occur at rest or with minimal exercise, often indicating an elevated risk of myocardial infarction. UAP is typically caused by acute coronary artery occlusion due to plaque rupture or erosion, leading to partial or complete obstruction of blood flow. This condition requires prompt medical intervention to prevent further complications and improve patient outcomes.[1,2] Despite advances in interventional treatment strategies, such as percutaneous coronary intervention (PCI), comprehensive management approaches addressing physiological and psychological dimensions of health are essential for optimal recovery.

Conventional medical management typically involves pharmacotherapy and lifestyle interventions, which may not completely address the complex stressors encountered by patients. This has prompted an investigation into complementary therapeutic options, including relaxation therapies.[3,4] Relaxation therapies aim to reduce physiological arousal through techniques such as breathing exercises and progressive muscle relaxation, potentially reducing myocardial workload and ischemic stress.[5]

In recent years, alternative therapies such as music therapy and relaxation therapy (RT) have gained traction in cardiovascular care.[6] Five-element music therapy (FEMT) (Wu Yin therapy), rooted in traditional Chinese philosophy, uses pentatonic melodies to restore psycho–physiological balance.[7] The integration of music and relaxation therapies might offer a promising complement to conventional treatment regimens, enhancing patient recovery through various mechanisms.[8,9] Studies suggest that music therapy can modulate the autonomic nervous system (ANS) by decreasing sympathetic activity and enhancing parasympathetic influence, which is particularly relevant in conditions like UAP where autonomic imbalance significantly contributes to disease progression.[10,11]

Despite the growing evidence supporting non-pharmacological interventions in cardiovascular care, limited data are available regarding the specific effects of combining FEMT with RT in the context of postinterventional recovery for elderly patients with UAP.[12] Given the complex interplay between physiological and psychological stressors in this patient population, investigating novel integrative therapies that might mitigate these challenges is essential.

This study aimed to examine the efficacy of FEMT combined with RT (FEMRT) in improving recovery outcomes among elderly patients following PCI for UAP.

MATERIALS AND METHODS

Case Selection and Grouping

This retrospective study included 287 elderly patients diagnosed with UAP who were treated at Wenzhou Yining Geriatric Hospital from April 2021 to April 2023. Patients were grouped based on the treatment method. Those who received only RT were defined as the RT group (n = 132), and those who received FEMT combined with RT were defined as the FEMRT group (n = 155).

The Institutional Review Board and Ethics Committee of Wenzhou Yining Geriatric Hospital approved this study (No. YJ-2024-01-01). We obtained informed consent from the patient. This research was conducted in accordance with the ethical principles outlined in the World Medical Association Declaration of Helsinki.[13]

Inclusion and Exclusion Criteria

Inclusion Criteria: (1) Patients diagnosed with UAP;[14] (2) age above 60 years; (3) clear consciousness and normal cognitive function; and (4) ability to articulate clearly and express feelings accurately.

Exclusion Criteria: (1) Coexisting severe primary diseases affecting the liver, kidneys, brain, or hematopoietic system; (2) presence of serious infectious diseases or mental illnesses; and (3) angina pectoris, arrhythmia, or heart failure resulting from other causes.

Treatment Methods

Treatment Course and Outpatient Follow-up

All patients received their treatments at the same rehabilitation center. The treatment course was 8 weeks, and the frequency was once every other day for three times a week. This schedule was selected to balance the need for regular monitoring and patient convenience. Flexible appointment times were arranged based on the individual needs of the patient. Patients received reminders via phone calls or text messages the day before their scheduled appointments to reduce no-show occurrences. Additionally, family members were encouraged to support patients in practicing relaxation techniques at home between sessions.

During out-of-hospital rehabilitation, patients’ medication adherence was assessed through a combination of pill counts, prescription refill records, and patient interviews.

RT

Patients in the RT group received RT. Part 1: Pursed-lip abdominal breathing training. Ensure full body relaxation and inhale through the nostrils, allowing the abdomen to expand outward as the diaphragm descends. During exhalation, purse the lips as if to whistle, raise the diaphragm, and draw the abdomen inward. The exhalation should be twice as long as the inhalation, performed three times daily for 20 min each session.[15]

Part 2: Progressive muscle relaxation. First, the patient was instructed to tense their muscles for 7 s. Second, the therapist performed relaxation massages following a specific order: forearms, biceps, face, shoulders and back, chest and abdomen, buttocks, thighs, and calves. This routine was repeated three times daily.

FEMT

Patients in the FEMRT group received FEMT combined with RT. FEMT implemented a focused listening method, where the therapist used melodies from traditional Chinese five-element music for treatment.[12] Five musical modes were used to address specific emotional states: (1) For emotional issues related to the wood element (e.g., anger), the Jue mode was used. (2) For emotional issues related to the fire element (e.g., anxiety or over-excitement), the Zhi mode was applied. (3) For emotional issues related to the earth element (e.g., worry or digestive discomfort), the Gong mode was employed. (4) For emotional issues related to the metal element (e.g., sadness or loss), the Shang mode was utilised. (5) For emotional issues related to the water element (e.g., fear or lack of security), the Yu mode was chosen. The volume was adjusted to ensure patient comfort. The total daily duration of music therapy was 2 hours, conducted in a specialised treatment room within the rehabilitation centre, without any intermission.[16]

Music therapy and RT were conducted concurrently. The therapist determined the appropriate start time of the sessions based on the individual patient’s circumstances.

Observation Indicators

Baseline Characteristics

Baseline data were collected through hospital electronic medical records, encompassing age, gender, body mass index, education level, marital status, comorbidities (hypertension, diabetes, abnormal blood lipids, myocardial infarction, heart failure, and arrhythmia), smoking habits, disease duration, types of PCI, cardiac function classification, and medication adherence. The cardiac function was classified by the New York Heart Association (NYHA) Classification standard.[17]

Treatment Efficacy

Treatment efficacy was assessed after 3 months of treatment. The treatment efficacy was divided into three levels: (1) markedly effective: Angina attacks decreased by more than 80%, and the electrocardiogram (ECG) test results returned to normal, (2) effective: angina attacks were diminished by 50%–80%, and ECG results significantly improved, and (3) ineffective: any outcome failing to meet these criteria.[18]

All following parameters were assessed at two time points: (1) before treatment: within 24 h prior to PCI, and (2) after treatment: 3 months after PCI.

Anxiety Level

The Self-Rating Anxiety Scale (SAS) is used to evaluate patient anxiety levels.[19] The Chinese version of the SAS, which has been validated and widely used in Chinese populations, was specifically employed in this study. The SAS encompasses four categories of symptoms: somatic (motor), autonomic, cognitive, and central nervous system symptoms. The SAS consists of 20 multiple-choice items. Each item is rated on a 4-point Likert scale ranging from 1 (none or a little of the time) to 4 (most or all of the time). The raw score was calculated by summing the responses to all items. The standard score was then derived by multiplying the raw score by 1.25, yielding a range of 25–100. Higher scores indicate greater levels of anxiety. A standard SAS score of ≥50 indicated a tendency towards anxiety. The Chinese version of the SAS had a Cronbach’s alpha of 0.78.

Quality of Life

The Seattle Angina Questionnaire (SAQ) was employed to evaluate patients’ quality of life. The standard scoring formula used was as follows: (actual score—lowest score in the domain)/(highest score in the domain—lowest score in the domain) × 100. The questionnaire comprises five components: physical limitation, angina stability, anginal frequency, treatment satisfaction, and disease perception.[20] Each component was scored on a scale of 0–100, with higher scores indicating a better quality of life and physiological functional status. The Cronbach’s alpha coefficient for this scale was 0.92, indicating high reliability.[21]

Echocardiographic Parameters

Echocardiographic parameters were assessed using an EPIQ 7C echocardiography system (Philips Ultrasound, Inc., the Netherlands). Patients were positioned in a supine orientation or on their left side. A 2–4 MHz frequency was utilised for 2D ultrasound to examine heart structures and obtain a four-chamber view. The probe’s direction was adjusted as necessary to conduct scans measuring the left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), and stroke volume (SV).

Serum Biomarkers

About 4 mL of venous blood was collected from fasting patients in the morning, with serum separation performed within 1 h. The serum levels of interleukin-6 (IL-6, Kit Manufacturer: EH2IL6, Thermo Fisher Scientific Inc., USA), tumour necrosis factor alpha (TNF-α, Kit Manufacturer: KHC3014C, Thermo Fisher Scientific Inc., USA), and N-terminal pro-brain natriuretic peptide (NT-proBNP, Kit Manufacturer: ab263877, ABCAM, the UK) were measured.

Statistical Method

Data analysis was conducted using SPSS statistical software version 29.0 (SPSS Inc., Chicago, IL, USA). Categorical variables were presented as (n [%], and a chi-square test was performed using standard formulas. The Shapiro–Wilk test was used to assess the normality of continuous variables. For normally distributed data, data were presented as mean ± standard deviation (X ± s) and compared using independent sample t-tests for two-group comparisons. All parameters (including heart rate, blood pressure, SAQ scores, LVEF, and serological markers) met the normality assumption, justifying the use of parametric tests. Data were presented as X̄ ± s. To quantify the effect size between groups, we calculated Cohen’s d using the following formula:

where X̄₁ and X̄₂ are the means of the two groups being compared; s_p is the pooled standard deviation, calculated as follows:

A two-sided P-value of <0.05 was considered statistically significant. All tables and [Figure 1] were created using Microsoft^® Word LTSCMSO (Version 2312 Build 16.0.17126.20132) 64-bit.

Figure 1.

Flowchart of this study.

Notes: UAP, unstable angina pectoris; RT, relaxation therapy; FEMRT: five-element music therapy.

RESULTS

Baseline Characteristics

The baseline characteristics of participants in the RT and FEMRT groups are presented in Table 1. We found no significant differences between the two groups in terms of age, gender distribution, body mass index, education levels, marital status, hypertension, diabetes, abnormal blood lipids, myocardial infarction, heart failure, arrhythmia, smoking habits, disease duration, types of PCI, cardiac function classification and medication adherence, with P values exceeding 0.05.

Table 1.

Baseline characteristics of participants

Parameters	RT group (n = 132)	FEMRT group (n = 155)	t/χ2	P
Age (years)	67.49 ± 5.34	66.35 ± 5.45	1.788	0.075
Gender (male/female) (n [%])	64 (48.48%)/68 (51.52%)	75 (48.39%)/80 (51.61%)	0	0.987
Body mass index (kg/m2)	21.36 ± 3.29	21.58 ± 3.11	0.569	0.570
Educational level (n [%])			0.263	0.877
Primary school and below	24 (18.18%)	31 (20.00%)
Middle school	45 (34.09%)	49 (31.61%)
College and above	63 (47.73%)	75 (48.39%)
Marital status (n [%])			2.864	0.239
Married	116 (87.88%)	145 (93.55%)
Divorced	12 (9.09%)	8 (5.16%)
Unmarried	4 (3.03%)	2 (1.29%)
Hypertension (n [%])	26 (19.70%)	34 (21.94%)	0.216	0.642
Diabetes (n [%])	21 (15.91%)	29 (18.71%	0.389	0.533
Abnormal blood lipids (n [%])	36 (27.27%)	39 (25.16%)	0.165	0.685
Myocardial infarction (n [%])	15 (11.36%)	20 (12.90%)	0.158	0.691
Heart failure (n [%])	8 (6.06%)	10 (6.45%)	0.019	0.892
Arrhythmia (n [%])	12 (9.09%)	15 (9.68%)	0.029	0.865
Smoke (n [%])	29 (21.97%)	32 (20.65%)	0.075	0.785
Course of disease (years)	4.36 ± 1.21	4.32 ± 1.25	0.290	0.772
Types of PCI (n [%])			0.648	0.723
Vascular stents	99 (75%)	110 (70.97%)
Balloon dilatation	20 (15.15%)	26 (16.77%)
Other	13 (9.85%)	19 (12.26%)
NYHA classification (n [%])			0.509	0.917
Class I	32 (24.24%)	39 (25.16%)
Class II	51 (38.64%)	54 (34.84%)
Class III	33 (25.00%)	43 (27.74%)
Class IV	16 (12.12%)	19 (12.26%)

FEMRT = five-element music therapy combined with relaxation therapy, PCI = percutaneous coronary intervention, RT = relaxation therapy, NYHA = New York Heart Association.

Treatment Efficacy

The treatment efficacy between the RT and FEMRT groups revealed statistically significant differences (P = 0.032) [Table 2]. Specifically, the FEMRT group demonstrated a higher proportion of markedly effective outcomes compared with the RT group. The proportion of effective outcomes was similar between the two groups. However, the RT group had a higher proportion of ineffective outcomes compared with the FEMRT group.

Table 2.

Comparison of treatment efficacy between the two groups

Parameters	RT group (n = 132)	FEMRT group (n = 155)	χ 2	P
Markedly effective	36 (27.27%)	59 (38.06%)	6.879	0.032
Effective	51 (38.64%)	63 (40.65%)
Ineffective	45 (34.09%)	33 (21.29%)

FEMRT = five-element music therapy combined with relaxation therapy, RT = relaxation therapy.

Anxiety Level

Prior to treatment, we found no significant difference in SAS scores between the RT group and the FEMRT group (P = 0.263), indicating comparable baseline anxiety statuses across groups [Table 3]. After treatment, a significant reduction in SAS scores was observed in both groups. However, the decrease was more pronounced in the FEMRT group than in the RT group (P = 0.006). Effect size analysis revealed clinically meaningful between-group differences in anxiety reduction: pre-treatment Cohen’s d was −0.133, confirming comparable baseline anxiety levels (P = 0.263). Postintervention, the FEMRT group demonstrated a small to moderate effect advantage (d = 0.329), equivalent to an additional 0.8-point (raw score difference = d × Pooled SD = 0.329 × 2.42 ≈ 0.8) reduction in SAS scores compared with the RT group.

Table 3.

Comparison of SAS scores between the two groups before and after treatment

Parameters	RT group (n = 132)	FEMRT group (n = 155)	t	P	Cohen’s d
Before treatment	42.28 ± 2.63	42.65 ± 2.82	1.121	0.263	−0.133
After treatment	37.63 ± 2.22	36.85 ± 2.47	2.779	0.006	0.329

FEMRT = five-element music therapy combined with relaxation therapy, RT = relaxation therapy, SAS = Self-Rating Anxiety Scale.

SAQ

Physical limitation significantly decreased in the FEMRT group than in the RT group (P = 0.008) [Table 4]. Participants in the FEMRT group also reported a more stable state of angina pectoris versus the RT group (P = 0.008). Angina frequency scores were higher in the FEMRT group than in the RT group, indicating a reduction in angina attacks (P = 0.006). The satisfaction level with treatment was enhanced in the FEMRT group than in the RT group (P = 0.006). Lastly, we found no significant difference in the disease perception between the two groups (P = 0.750). Cohen’s d analysis indicated small-to-moderate FEMRT advantages in physical limitation, angina stability, frequency, and treatment satisfaction but not in disease perception.

Table 4.

Comparison of the scores of each dimension of the SAQ between the two groups after treatment

Parameters	RT group (n = 132)	FEMRT group (n = 155)	t	P	Cohen’s d
Physical limitation	69.12 ± 4.75	70.58 ± 4.46	2.679	0.008	−0.317
Angina stability	60.03 ± 4.36	61.45 ± 4.58	2.664	0.008	−0.315
Angina frequency	61.19 ± 5.26	62.72 ± 3.69	2.794	0.006	−0.340
Treatment satisfaction	65.07 ± 5.21	66.98 ± 6.42	2.780	0.006	−0.324
Disease perception	67.75 ± 4.57	67.94 ± 5.56	0.319	0.750	−0.037

FEMRT = five-element music therapy combined with relaxation therapy, RT = relaxation therapy. SAQ = Seattle Angina Questionnaire.

Echocardiographic Parameters

Before treatment, we found no statistically significant differences in SV, LVEF, LVEDD, or LVESD (all P > 0.05) between the RT and FEMRT groups [Table 5]. After treatment, both groups showed improvements in all echocardiographic parameters, with no significant differences between them. SV and LVEF increased in the FEMRT group compared with the RT group; LVEDD and LVESD decreased in the FEMRT group compared with the RT group. These Cohen’s d values indicated that the differences in heart function parameters between the RT and FEMRT groups were negligible to small. Both therapies led to improvements in heart function, but the addition of FEMRT did not correlate with additional benefits over standard RT for elderly patients after interventional treatment for UAP.

Table 5.

Comparison of heart function between the two groups before and after treatment

Parameters	RT group (n = 132)	FEMRT group (n = 155)	t	P	Cohen’s d
Before treatment
SV (mL)	65.45 ± 8.21	65.16 ± 8.19	0.301	0.764	0.036
LVEF (%)	48.35 ± 3.48	48.52 ± 3.16	0.446	0.656	−0.053
LVEDD (mm)	55.42 ± 4.25	55.19 ± 4.73	0.427	0.670	0.051
LVESD (mm)	48.44 ± 1.32	48.24 ± 1.65	1.171	0.242	0.136
After treatment
SV (mL)	79.36 ± 6.54	79.96 ± 6.75	0.761	0.447	−0.090
LVEF (%)	65.79 ± 7.01	65.95 ± 7.28	0.196	0.845	−0.023
LVEDD (mm)	45.69 ± 4.21	44.98 ± 4.01	1.471	0.142	0.174
LVESD (mm)	43.36 ± 2.69	43.03 ± 2.61	1.072	0.285	0.127

FEMRT = five-element music therapy combined with relaxation therapy, LVEDD = left ventricular end diastolic diameter, LVEF = left ventricular ejection fraction, LVESD = left ventricular end systolic diameter, RT = relaxation therapy, SV = Stroke volume.

Serum Biomarkers

Before treatment, we found no significant differences in TNF-α, IL-6, or NT-proBNP (all P > 0.05) levels between the RT and FEMRT groups [Table 6]. After treatment, both groups showed a reduction in these biomarkers, with no significant differences between them (P > 0.05). The effect sizes, as measured by Cohen’s d, for these indicators were minimal. Although both therapies contributed to the reduction in inflammation and cardiac stress markers, the addition of FEMT combined with RT did not lead to additional benefits over standard RT for elderly patients after interventional treatment for UAP.

Table 6.

Serum biomarkers between the two groups before and after treatment

Parameters	RT group (n = 132)	FEMRT group (n = 155)	t	P	Cohen’s d
Before treatment
TNF-α (µg/L)	1.88 ± 0.21	1.85 ± 0.19	1.354	0.177	0.160
IL-6 (ng /L)	105.34 ±10.58	104.92 ± 11.25	0.317	0.751	0.038
NT-proBNP (ng /L)	512.56 ± 54.36	515.65 ± 55.21	0.476	0.635	-0.056
After treatment
TNF-α (µg/L)	1.03 ± 0.24	1.01 ± 0.25	0.749	0.455	0.089
IL-6 (ng/L)	71.38 ± 6.32	70.85 ± 6.16	0.719	0.473	0.085
NT-proBNP (ng/L)	289.36 ± 48.55	287.69 ± 49.58	0.287	0.774	0.034

FEMRT = five-element music therapy combined with relaxation therapy, IL-6 = interleukin-6, NT-proBNP = N-terminal pro-brain natriuretic peptide, RT = relaxation therapy, TNF-α = tumour necrosis factor-α.

DISCUSSION

This retrospective analysis investigated the effects of combining FEMT with RT on elderly patients with UAP after PCI.

The significant difference in treatment efficacy between the FEMRT and RT groups highlights the possibility of combined non-pharmacological interventions to enhance recovery in patients with unstable angina. The observed reductions in angina attacks and improvements in ECG outcomes in the FEMRT group suggested that FEMRT may exert beneficial effects on symptom stabilisation. These therapies likely enhance ANS balance, a critical factor in cardiovascular stress responses.[22] Music therapy, with its structured and rhythmic elements, may reduce sympathetic nervous system activity and stimulate the parasympathetic nervous system, thereby lowering myocardial oxygen demand and improving coronary microcirculation, which are crucial in angina management.[23]

The biological mechanisms by which FEMT affects cardiovascular function are based on its control of the ANS. FEMT may enhance parasympathetic activity and reduce sympathetic arousal, contributing to myocardial relaxation and vasodilation and reducing cardiovascular load.[24,25] Additionally, the psychological benefits of FEMT, such as reduced stress and elevated mood, complement these physiological effects, resulting in improved cardiovascular outcomes.[26]

A crucial part of this study was the reduction in anxiety levels. The comprehensive framework of FEMT helps address different emotional spectra by modulating mood and stress hormones, mainly through pathways involving the hypothalamic–pituitary–adrenal axis. Music effectively engages the brain’s emotional and reward circuits, leading to a reduction in cortisol levels and an increase in the release of endorphins and other neuropeptides associated with relaxation and happiness.[27] Thus, these biochemical and neurological transformations account for the significant reduction in anxiety observed among FEMRT patients compared with those who solely received RT.

The findings from the SAQ indicated that patients in the FEMRT group experienced better quality of life, fewer physical activity limitations, greater angina stability, and higher treatment satisfaction than those in the RT group. These improvements were likely multifactorial, with the unique properties of FEMT playing a pivotal role. FEMT incorporates traditional Chinese musical elements aligned with the five elemental phases (wood, fire, earth, metal, and water), which are believed to harmonise the body’s energy systems and foster emotional balance. The educative and reflective components of FEMT, combined with relaxation techniques, encourage proactive health behaviours and adherence to treatment protocols. Enhanced patient engagement and empowerment via FEMT were critical in chronic disease management, often translating into improved prognostic outcomes and heightened therapeutic efficacy.[28,29]

Despite improvements in echocardiographic parameters (LVEF and LVEDD) and serum biomarkers (TNF-α and IL-6), no significant intergroup differences were observed. Potential reasons included the following: (1) intervention duration: The 3-month timeframe might be insufficient for structural cardiac remodelling, as echocardiographic changes typically require ≥6 months in post-PCI populations;[30] (2) ceiling effect: Conventional RT alone may optimise autonomic regulation to near-maximal capacity in this cohort; and (3) biomarker sensitivity: Serum cytokines like IL-6 have short half-lives (1–5 h) and high diurnal variability,[31] potentially masking cumulative effects. Future trials should incorporate long follow-ups and stress-responsive biomarkers to fully capture the long-term benefits of FEMT.

The psychological component of FEMT should not be overlooked. This therapy provided an outlet for emotional expression and catharsis, enabling patients to process and manage their affective states successfully. By aligning with the five elemental phases, FEMT facilitated emotional balancing, translating into decreased perceptions of pain and discomfort, heightened emotions of relaxation and happiness, and enhanced self-control over health outcomes.[32] By reducing psychological distress, this therapy might relieve the perceived severity of angina symptoms, contributing to improved self-reported quality of life indicators.

The underlying mechanisms of our findings can be conceptually related to broad biopsychosocial models of health, emphasising the interplay among biological processes, psychological states, and social factors. The therapy is founded in traditional Chinese medicine and may enhance emotional resonance among patients, thereby increasing placebo and nocebo effects through patient–provider congruence. The alignment of auditory stimuli with natural rhythms and patterns in music therapy may resonate with intrinsic biological rhythms, possibly modulating physiological responses and enhancing homeostasis.[22,27]

Relating the findings to existing literature reveals consistency with previous studies that demonstrate the efficacy of music therapy in improving cardiovascular outcomes and mental health. Systematic reviews and meta-analyses have reported improved pain management, reduced anxiety, and decreased cardiac complications in patients receiving music therapy, supporting our study’s results. Moreover, the cognitive behavioural features inherent in RT, such as progressive muscle relaxation, were well-documented to induce calming effects and could be rationalised as moderators of cardiovascular function.[33]

Despite these promising outcomes, several limitations of this study warrant consideration. This retrospective analysis was limited by intrinsic biases, such as selection bias and the potential influence of unaccounted confounding factors. Future research should aim to utilise randomised controlled trials to validate and enhance these findings, providing a robust causal inference for the therapeutic efficacy of combined FEMT and RT. Given the exploratory nature of analysing multiple secondary outcomes, we applied no statistical corrections for multiplicity. Findings should emphasise effect sizes and biological plausibility over isolated p-values, with replication recommended in future confirmatory trials. Moreover, our study suggested significant improvements in subjective outcomes, but it did not reveal significant differences in key physiological parameters. Although the combined therapy may offer benefits in psychological and emotional domains, its effect on cardiovascular function requires further investigation.

CONCLUSION

This study investigated the effects of integrating FEMRT on elderly patients with UAP following PCI. Our findings demonstrated that this combined therapy significantly improved patient-reported outcomes, particularly in reducing anxiety and enhancing quality of life. Our results suggested that incorporating psychological dimensions into the therapeutic regimen may benefit patients with UAP; however, further research is needed to confirm the extent of these benefits and explore their broad application. Future efforts should elucidate the underlying mechanisms and optimise these therapies for broad clinical implementation.

Availability of Data and Materials

The datasets used during the present study are available from the corresponding author upon reasonable request.

Author Contributions

Yinqing Huang designed the research study and provided help and advice on the experiments. Shanshan Lin analyzed the data. Yinqing Huang and Yuanwei Zheng contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

Ethics Approval and Consent to Participate

The Institutional Review Board and Ethics Committee of Wenzhou Yining Geriatric Hospital approved this study (No. YJ-2024-01-01). We obtained informed consent from the patient.

Conflicts of Interest

No conflicts of interest exist in the submission of this manuscript.

Funding Statement

None.