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Heart disease is the leading cause of global mortality, accounting for 13.7 million deaths annually. Optimising depression andanxiety symptoms in adults with heart disease is an international priority. Heart disease secondary prevention is best achievedthrough implementation of sustainable pharmacological and non-pharma cological interventions, including meditation.Meditation is a means of generating self-awareness and has implications for enhanced self-management of depression andanxiety symptoms. This review aims to identify high-level quantitative evidence for meditation interventions designed toimprove depression and/or anxiety symptoms among adults with heart disease and ascertain the most important elements ofmeditation interventions that facilitate positive depression and/or anxiety outcomes. This systematic review and narrative syn-thesis was completed in accordance with the PRISMA Statement and has adhered to the Cochrane Risk of Bias guideline. Sixdatabases were searched between 1975 and 2017. Statistically significant outcomes were demonstrated in over half (5/9) of phaseII meditation studies for depression and/or anxiety and involved 477 participants. Meditation interventions that generated positiveoutcomes for depression and/or anxiety included elements such as focused attention to body parts (or body scan) (3/4 studies)and/or group meetings (4/5 studies). Meditation is a means of reframing heart disease outpatient services towards an integratedmodel of care. Future adequately powered phase III studies are needed to confirm which meditation elements are associated withreductions in depression and anxiety; and the differential effects between concentrative and mindfulness-based meditation typesamong adults with heart disease.