The telephone lifestyle intervention 'Hartcoach' has modest impact on coronary risk factors: A randomised multicentre trial

Comparative efficacy and adherence of telehealth cardiac rehabilitation interventions for patients with cardiovascular disease: A systematic review and network meta-analysis

BACKGROUND

Traditional center-based cardiac rehabilitation had low adherence rates. With the increasing utilization of digital technology in healthcare services, telehealth can overcome common barriers to improve adherence, and some telehealth interventions have been proven safe and effective. However, it remains unclear which telehealth intervention types can maximize the efficacy and adherence for cardiac rehabilitation.

OBJECTIVE

To compare the effect of different types of telehealth interventions on the efficacy and adherence of patients with cardiovascular disease in cardiac rehabilitation.

DESIGN

Systematic review and network meta-analysis.

METHODS

We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, ProQuest, Scopus, and Embase databases for randomized controlled trials of telehealth cardiac rehabilitation for cardiovascular disease patients from January 2013 to March 2024. The primary outcomes were peak oxygen uptake (VO2 peak) and adherence. Secondary outcomes included 6-minute walking distance, moderate-to-vigorous intensity physical activity, depression, self-reported quality of life, and patient satisfaction. The study protocol has been registered on PROSPERO (ID: CRD42023459643).

RESULTS

This network meta-analysis included 46 randomized controlled trials. The results indicated that telehealth cardiac rehabilitation improved VO2 peak, 6-minute walking distance, moderate-to-vigorous intensity physical activity, and adherence. The surface under the cumulative ranking curve (SUCRA) results showed that the Wearable Devices + Smartphone Applications (SUCRA = 86.8 %, mean rank = 1.7) was the most effective telehealth intervention for improving VO2 peak. The Smartphone Applications + Instant Communication Tools (SUCRA = 74.2 %, mean rank = 2.6) was the most effective telehealth intervention for promoting adherence.

CONCLUSIONS

Combining two or more types of telehealth interventions was found to be effective. Future efforts should prioritize conducting high-quality randomized controlled trials to identify more effective combinations with traditional cardiac rehabilitation.

Preliminary Effects of a Structured Educational Program in Cardiac Patients at Different Stages of Enrollment in Cardiovascular Rehabilitation

This quasi-experimental study investigated the preliminary effects of a structured education intervention in a pooled sample of cardiovascular rehabilitation (CR) patients in Brazil. Recently enrolled (RE) and long-term enrolled (LTE) patients attended 12 weekly education sessions in addition to three weekly exercise sessions. Patients completed surveys assessing disease-related knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was assessed by the 6-minutes walking test. All outcomes were assessed at pre-,post-CR, and 6-months follow-up. Bonferroni correction was applied. In total, 69 (69.7%) patients completed all three assessments. There were significant improvements in knowledge pre-to post-test in both subgroups (p < 0.001), and in functional capacity (p ≤ 0.001) and food intake (p ≤ 0.001) pre-to post-test in the RE subgroup. Post-test knowledge was correlated to physical activity, functional capacity and health literacy. This preliminary study suggests the importance of structured education for CR patients. A larger study using a randomized controlled design is needed to determine efficacy.

The effect of web-based education delivered as part of cardiac rehabilitation on healthy lifestyle behaviors, and quality of life in patients with coronary artery disease in Turkey: A randomised controlled trial

OBJECTIVE

This study was conducted to evaluate the effect of web-based education delivered as part of cardiac rehabilitation (CR) on healthy lifestyle behaviors, and quality of life in patients with coronary artery disease (CAD) in Turkey.

METHOD

This study is a randomized controlled trial. The experimental group (n = 35) received web-based education and telephone counseling for 12 weeks after discharge, while the control group (n = 35) received standard care.

RESULTS

Post-test healthy lifestyle behaviors scale total score and total scores of all sub-dimensions except nutrition were higher in the experimental group (p < 0.05). The post-test international physical activity total score, and VAS scale scores of the experimental group and were significantly higher (p < 0.05). The number of non-smoking patients in the post-test was statistically significantly higher in the experimental group (p < 0.05).

CONCLUSION

The results showed that web-based education delivered as part of CR in a Turkish hospital improved healthy lifestyle behaviors, physical activity level, and quality of life in CAD.

PRACTICE IMPLICATIONS

Our study proved that web-based education delivered as part of CR, nurse follow-up, and telephone counseling services may be effective tools for CAD patients to adhere to healthy lifestyle behaviors, and to promote quality of life and smoking cessation.

2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

AIM

The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease."

METHODS

A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

STRUCTURE

This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

AIM

The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease."

METHODS

A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

STRUCTURE

This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Lifestyle medicine for anxiety symptoms: A meta-analysis of randomized controlled trials

BACKGROUND

Lifestyle medicine (LM) is gaining increasing attention as a treatment option for anxiety, but the current state of evidence has not yet been systematically examined.

METHODS

Six electronic databases were systematically searched from inception to February 2022. Randomized controlled trials (RCTs) comparing the effects of multicomponent LM interventions on anxiety symptoms with either care-as-usual, waitlist, no intervention, or attention control group on anxiety symptoms were identified.

RESULTS

A total of 53 RCTs with 18,894 participants were included for qualitative synthesis, in which 45 RCTs with data available were included for meta-analysis. Multicomponent LM intervention was significantly more effective than the control groups in reducing anxiety symptoms at immediate posttreatment (d = 0.19, p < .001) and at short-term follow-up (d = 0.29, p < .001). However, no significant difference at medium-term was found (p = .14), whereas more studies are needed to study the long-term effects. The subgroup analyses suggested that baseline anxiety symptoms was a significant moderator, suggesting that those with moderate level of baseline anxiety symptoms appeared to have greater improvements (d = 0.66, p < .05).

LIMITATIONS

Minimal anxiety symptoms at baseline contributed to the floor effect and influenced the degree of improvement. The included RCTs had a high risk of bias in general with potential publication bias detected.

CONCLUSION

The findings of this meta-analysis provided support for the positive effects of multicomponent LM interventions for anxiety symptoms. Future research is needed to determine the long-term effects of multicimponent LM and the optimal baseline anxiety severity.

Lifestyle medicine for depression: A meta-analysis of randomized controlled trials

BACKGROUND

The treatment effect of multi-component LM interventions on depressive symptoms has not yet been examined.

METHODS

We systematically searched six databases from inception to February 2020 to identify randomized controlled trials (RCTs) involving any multi-component LM interventions (physical activity, nutritional advice, sleep management, and/or stress management) on depressive symptoms relative to care as usual (CAU), waitlist (WL), no intervention (NI), or attention control (AC) comparisons.

RESULTS

Fifty studies with 8,479 participants were included. Multi-component LM interventions reduced depressive symptoms significantly relative to the CAU (p >.001; d = 0.20) and WL/NI (p > .01; d = 0.22) comparisons at immediate posttreatment. However, no significant difference was found when compared with AC. The intervention effects were maintained in the short-term (1- to 3-month follow-up) relative to the CAU comparison (p > .05; d = 0.25), but not in the medium- and long-term. The moderator analyses examining the effect of multi-component LM interventions compared with CAU suggested that the number of lifestyle factors adopted was a significant moderator. Although disease type was not a significant moderator, there was a tendency that the clinical effect of multi-component LM interventions was stronger (d = 0.45) in those diagnosed with major depression. No publication bias was detected.

LIMITATIONS

Low number of RCTs available in some subgroup analyses prevented from finding meaningful effects. Results may not be extended to major depression, because data on secondary depression were captured.

CONCLUSION

Multi-component LM interventions appeared to be effective in mitigating depressive symptoms; however, the magnitude of the clinical effect was small. Future research is needed to assess more comprehensive and individualized LM interventions which have a greater emphasis on motivational and compliance aspects and focus solely on individuals with depression.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Cardiovascular Prevention Guidelines

We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.

[Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Cardiovascular Prevention Guidelines]

We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.

Impact of technology-based patient education on modifiable cardiovascular risk factors of people with coronary heart disease: A systematic review

OBJECTIVE

To collect evidence on what types of technology and content are most effective in helping people with coronary heart disease (CHD) to change their modifiable cardiovascular risk factors.

METHODS

A literature search was performed to find relevant studies published between 1 January 2008 and 31 December 2018 in PubMed, CINAHL, PROQUEST and Scopus databases. Selected outcomes were risk factors (exercise, diet, blood pressure, blood sugar, cholesterol, body mass index, tobacco use). The quality of the studies was evaluated according to Joanna Briggs Institute Reviewers Manual Checklists for risk for bias, TIDieR for quality of interventions, and PRISMA statement for presenting results.

RESULTS

Eighteen quantitative (17 RCT´s and one quasi-experimental) studies were included. Patient education delivered through telephone, text messaging, webpages, and smartphone applications resulted in significant changes in some risk factors of people with CHD. Sufficient descriptions of the content and intervention methods were lacking.

CONCLUSION

Patient education delivered with technology can help people with CHD to modify their risk factors. There is a need for better descriptions of the content and delivery of educational interventions in studies.

PRACTICE IMPLICATIONS

Patient education needs to be delivered with technological solutions that best support the multidimensional needs of CHD patients.

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

European guidelines on cardiovascular prevention in clinical practice were first published in 1994 and have been regularly updated, most recently in 2016, by the Sixth European Joint Task Force. Given the amount of new information that has become available since then, components from the task force and experts from the European Association of Preventive Cardiology of the European Society of Cardiology were invited to provide a summary and critical review of the most important new studies and evidence since the latest guidelines were published. The structure of the document follows that of the previous document and has six parts: Introduction (epidemiology and cost effectiveness); Cardiovascular risk; How to intervene at the population level; How to intervene at the individual level; Disease-specific interventions; and Settings: where to intervene? In fact, in keeping with the guidelines, greater emphasis has been put on a population-based approach and on disease-specific interventions, avoiding re-interpretation of information already and previously considered. Finally, the presence of several gaps in the knowledge is highlighted.

Effectiveness of telehealth interventions as a part of secondary prevention in coronary artery disease: a systematic review and meta-analysis

BACKGROUND

Coronary artery disease is one of the most important health problems among heart diseases in the world, with high morbidity and mortality. Lifestyle changes in particular are recommended in the latest guidelines for implementing secondary prevention.

AIM

The aim of this study was to evaluate the effectiveness of telehealth interventions as a part of secondary prevention compared to routine care in those with coronary artery disease.

METHOD

The systematic review with meta-analysis was performed in accordance with Cochrane methods. Science Direct, Springer Link, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, ProQuest and Network Digital Library databases were searched between 2000 and 2018 up to February 2018. The studies chosen conformed to PICOS inclusion and exclusion criteria. The risk of bias was assessed using the Cochrane risk of bias tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used in reporting the study.

RESULTS

Twenty-four studies with a total of 6773 study participants met the inclusion criteria. It was found that telephone call interventions were the most commonly used, text message interventions came second with seven studies, telephone calls in combination with messages were used in four studies and telemonitoring was used in two studies. Compared to routine care, telehealth interventions had moderate significant effects in reducing waist circumference, total cholesterol and triglyceride, improving medication adherence and physical activity, and had small significant effects in reducing blood pressure and smoking cessation. No significant publication bias was found in the main outcomes.

CONCLUSION

Results showed that the telehealth interventions yielded positive outcomes in lifestyle changes for coronary artery disease. Therefore, telehealth interventions can be used for effective secondary prevention by health professionals who care for individuals with coronary artery disease. Additionally, this study will provide guidance for studies on the development of telehealth intervention.

Peer Benchmarking and Norm-Based Scoring to Improve Telephonic Health Coaching Quality

BACKGROUND

Studies evaluating telephonic coaching to improve population health have focused on outcomes, but measurement of consistency of coaching quality is also needed. The aim of this study was to describe how one multistate health plan developed, scored, and implemented a Coach Case Quality Assessment (CCQA) for quality improvement.

METHODS

The nine-item CCQA is a checklist of elements selected by quality improvement teams for peer benchmarking to improve telephonic coaching. The health plan fielded the CCQA to 470 clinical coaches in 2016. Quality reviewers rated coaches' call quality on each item (1 = learning; 2 = progressing; 3 = succeeding) and planned training around composite scores in relation to team norms.

RESULTS

A total of 470 coaches completed CCQAs with a norm-based mean score of 50.0 (standard deviation [SD] ± 10.0); 54.0% of coaches had scores within ±1 SD of the mean ("norm"), with 20.9% of coaches scoring below that range, and 25.1% scoring above it. Ninety-six percent (451/470) of coaches completed a nine-month follow-up. The mean norm-based score improved to 56.2 (SD ± 9.3), with 8.2% performing below, 42.4% at, and 49.4% above the peer norm. Scores represent significant mean and proportional changes over time, reflecting improvement on the part of whole teams.

CONCLUSION

This study demonstrates norm-based scoring as an effective strategy for measuring and improving coaching quality in a telephonic behavioral change program. Health plans can implement case quality review with norm-based scoring and peer benchmarking to aid coaches in continuous quality improvement.

Comparative Effectiveness of the Core Components of Cardiac Rehabilitation on Mortality and Morbidity: A Systematic Review and Network Meta-Analysis

A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating the core components of cardiac rehabilitation (CR), nutritional counseling (NC), risk factor modification (RFM), psychosocial management (PM), patient education (PE), and exercise training (ET)) was undertaken. Published RCTs were identified from database inception dates to April 2017, and risk of bias assessed using Cochrane's tool. Endpoints included mortality (all-cause and cardiovascular (CV)) and morbidity (fatal and non-fatal myocardial infarction (MI), coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and hospitalization (all-cause and CV)). Meta-regression models decomposed treatment effects into the main effects of core components, and two-way or all-way interactions between them. Ultimately, 148 RCTs (50,965 participants) were included. Main effects models were best fitting for mortality (e.g., for all-cause, specifically PM (hazard ratio HR = 0.68, 95% credible interval CrI = 0.54⁻0.85) and ET (HR = 0.75, 95% CrI = 0.60⁻0.92) components effective), MI (e.g., for all-cause, specifically PM (hazard ratio HR = 0.76, 95% credible interval CrI = 0.57⁻0.99), ET (HR = 0.75, 95% CrI = 0.56⁻0.99) and PE (HR = 0.68, 95% CrI = 0.47⁻0.99) components effective) and hospitalization (e.g., all-cause, PM (HR = 0.76, 95% CrI = 0.58⁻0.96) effective). For revascularization (including CABG and PCI individually), the full interaction model was best-fitting. Given that each component, individual or in combination, was associated with mortality and/or morbidity, recommendations for comprehensive CR are warranted.

Effects of two behavioral cardiac rehabilitation interventions on physical activity: A randomized controlled trial

BACKGROUND

Standard cardiac rehabilitation (CR) is insufficient to help patients achieve an active lifestyle. The effects of two advanced and extended behavioral CR interventions on physical activity (PA) and sedentary behavior (SB) were assessed.

METHODS

In total, 731 patients with ACS were randomized to 1) 3months of standard CR (CR-only); 2) 3months of standard CR with three pedometer-based, face-to-face PA group counseling sessions followed by 9months of aftercare with three general lifestyle, face-to-face group counseling sessions (CR+F); or 3) 3months of standard CR, followed by 9months of aftercare with five to six general lifestyle, telephonic counseling sessions (CR+T). An accelerometer recorded PA and SB at randomization, 3months, 12months, and 18months.

RESULTS

The CR+F group did not improve their moderate-to-vigorous intensity PA (MVPA) or SB time compared to CR-only (between-group difference=0.24% MVPA, P=0.349; and 0.39% SB, P=0.529). However, step count (between-group difference=513 steps/day, P=0.021) and time in prolonged MVPA (OR=2.14, P=0.054) improved at 3months as compared to CR-only. The improvement in prolonged MVPA was maintained at 18months (OR=1.91, P=0.033). The CR+T group did not improve PA or SB compared to CR-only.

CONCLUSIONS

Adding three pedometer-based, face-to-face group PA counseling sessions to standard CR increased daily step count and time in prolonged MVPA. The latter persisted at 18months. A telephonic after-care program did not improve PA or SB. Although after-care should be optimized to improve long-term adherence, face-to-face group counseling with objective PA feedback should be added to standard CR.

Does a Nurse-Led Program of Support and Lifestyle Management for patients with coronary artery disease significantly improve psychological outcomes among the patients?: A meta-analysis

BACKGROUND

Nowadays, secondary prevention of coronary heart disease (CHD) is commonly provided by nurse-coordinated prevention programs (NCPPs). NCPPs were recommended to be incorporated into the healthcare systems by the European Society of Cardiology (ESC) as stated in their 2012 European Guideline. Even if Nurse-Led Programs of Support and Lifestyle Management are beneficial to the patients with CHD, it is not clear whether these programs significantly improve psychological outcomes among the patients. Therefore, in this analysis, we aimed to systematically compare anxiety and depression reported among CHD patients who were assigned to a Nurse-Led Programs of Support and Lifestyle Management versus patients who were assigned to a normal usual care setting.

METHODS

Online databases were searched for English publications assessing anxiety and depression in CHD patients who were assigned to a Nurse Interventional program versus patients who were assigned to a normal usual care setting. This analysis was carried out by RevMan software (version 5.3). For dichotomous data, odds ratios (ORs) and 95% confidence intervals (CIs) were generated whereas for continuous data, weight mean difference (WMDs) and 95% CIs were calculated.

RESULTS

A total number of 3110 patients were analyzed (1526 participants were assigned to the Nurse Interventional group whereas 1584 participants were assigned to the normal usual care group). Patients' enrollment time period varied from the year 2008 to the year 2015. Results of this analysis showed that depression among participants who were assigned to a Nurse-Led Program of Support and Lifestyle Management was not significantly different (OR: 0.90, 95% CI: 0.68-1.20; P = .47) compared to participants who were assigned to the normal usual care setting. When continuous data were used, still no significant difference was observed (WMD: -0.83, 95% CI: -1.68-0.02; P = .06). A similar result was obtained even when anxiety was assessed (WMD: -1.38, 95% CI: -3.21-0.45; P = .14).

CONCLUSIONS

The current analysis did not show any significant improvement in reduction of depression and anxiety among CHD patients who were assigned to a Nurse-Led Program of Support and Lifestyle Management versus those patients who were assigned to a normal usual care setting. Therefore, according to this analysis, even if a Nurse-Led Program of Support and Lifestyle Management might be clinically effective, it does not improve mental well-being in these patients with CHD.

Treatment of Anxiety in Patients With Coronary Heart Disease: A Systematic Review

BACKGROUND

Anxiety is common in patients with coronary heart disease (CHD) and is associated with an increased risk for adverse outcomes. There has been a relative paucity of studies concerning treatment of anxiety in patients with CHD.

OBJECTIVE

We conducted a systematic review to organize and assess research into the treatment of anxiety in patients with CHD.

METHODS

We searched CCTR/CENTRAL, MEDLINE, EMBASE, PsycINFO, and CINAHL for randomized clinical trials conducted before October 2016 that measured anxiety before and after an intervention for patients with CHD.

RESULTS

A total of 475 articles were subjected to full text review, yielding 112 publications that met inclusion criteria plus an additional 7 studies from reference lists and published reviews, yielding 119 studies. Sample size, country of origin, study quality, and demographics varied widely among studies. Most studies were conducted with nonanxious patients. The Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory were the most frequently used instruments to assess anxiety. Interventions included pharmacological, counseling, relaxation-based, educational, or "alternative" therapies. Forty (33% of total) studies reported that the interventions reduced anxiety; treatment efficacy varied by study and type of intervention. Elevated anxiety was an inclusion criterion in only 4 studies, with inconsistent results.

CONCLUSION

Although there have been a number of randomized clinical trials of patients with CHD that assessed anxiety, in most cases anxiety was a secondary outcome, and only one-third found that symptoms of anxiety were reduced with treatment. Future studies need to target anxious patients and evaluate the effects of treatment on anxiety and relevant clinical endpoints.

Randomised controlled trial of two advanced and extended cardiac rehabilitation programmes

OBJECTIVE

The OPTICARE (OPTImal CArdiac REhabilitation) randomised controlled trial compared two advanced and extended cardiac rehabilitation (CR) programmes to standard CR for patients with acute coronary syndrome (ACS). These programmes were designed to stimulate permanent adoption of a heart-healthy lifestyle. The primary outcome was the SCORE (Systematic COronary Risk Evaluation) 10-year cardiovascular mortality risk function at 18 months follow-up.

METHODS

In total, 914 patients with ACS (age, 57 years; 81% men) were randomised to: (1) 3 months standard CR (CR-only); (2) standard CR including three additional face-to-face active lifestyle counselling sessions and extended with three group fitness training and general lifestyle counselling sessions in the first 9 months after standard CR (CR+F); or (3) standard CR extended for 9 months with five to six telephone general lifestyle counselling sessions (CR+T).

RESULTS

In an intention-to-treat analysis, we found no difference in the SCORE risk function at 18 months between CR+F and CR-only (3.30% vs 3.47%; p=0.48), or CR+T and CR-only (3.02% vs 3.47%; p=0.39). In a per-protocol analysis, two of three modifiable SCORE parameters favoured CR+F over CR-only: current smoking (13.4% vs 21.3%; p<0.001) and total cholesterol (3.9 vs 4.3 mmol/L; p<0.001). The smoking rate was also lower in CR+T compared with the CR-only (12.9% vs 21.3%; p<0.05).

CONCLUSIONS

Extending CR with extra behavioural counselling (group sessions or individual telephone sessions) does not confer additional benefits with respect to SCORE parameters. Patients largely reach target levels for modifiable risk factors with few hospital readmissions already following standard CR.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT01395095; results.

Effect of goal attainment theory based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: Randomized study

Effect of goal-attainment-theory-based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: randomized study BACKGROUND: The behavioral modification strategies should be explored at the time of admission to lead the maximum effect of cardiovascular risk management.

AIMS

This randomized study aimed to elucidate the effects of a nurse-led theory-based education program in individuals with a first episode of acute myocardial infarction on cardiovascular risks, health behaviors, and quality of life over 6 months.

METHODS

The study involved a convenience sample of 64 patients with acute myocardial infarction who were randomly assigned to either the education group or the control group. The goal-attainment-based education program was designed to set the mutually agreed goals of risk management and the behavioral modification strategies for achieving those goals. Those in the control group received routine management only. The participants in both groups were contacted at 6-8 weeks and at 6 months after discharge to measure outcome variables. Repeated measure ANOVA was conducted using SPSSWIN (version 20.0) to determine the significance of differences in outcome variables over 6 months between the groups.

RESULTS

Both groups showed significant positive changes in cardiovascular risks, health behaviors, and quality of life over 6 months. The 2-year risk of cardiovascular disease was significantly reduced in both study groups, but with no significant interaction effect (F=2.01, p=0.142). The performance and maintenance of health behaviors (F=3.75, p=0.029) and the mental component of quality of life (F=4.03, p=0.020) were significantly better in the education group than the control group.

CONCLUSION

Applying a goal-oriented education program at an early stage of hospital management improved and maintained blood glucose, health behaviors, and mental component of the quality of life up to six months in individuals with a first episode of myocardial infarction. Further studies are warranted to explore the role of behavioral modification mediating between cardiovascular risk management and quality of life in this population.

Randomized Trials of Nurse-Delivered Interventions in Weight Management Research: A Systematic Review

The purpose of this systematic review was to determine whether nurse-delivered weight management interventions improve weight outcomes across the life span. We conducted a comprehensive search of the PubMed, CINAHL, and PsycINFO electronic databases. We graded the trials using an adapted Jadad approach for methodological quality. The search identified a total of 1,159 citations; 23 articles from 20 studies were eligible for this review. Sixty-five percent of the studies reported significant findings related to body mass index (BMI) or weight reduction. Studies that were particularly successful at helping participants reduce weight and/or BMI involved nurses engaged in health promotion activities, operating within multidisciplinary teams and/or providing consultations, physical activity education, and coaching over the phone. Of the studies that involved long-term follow-up assessments, three out of nine studies showed a significant loss in weight or BMI between the intervention and control groups at follow-up times ranging from 12 months to 2 years.