The Effect of Telephone Support Interventions on Coronary Artery Disease (Cad) Patient Outcomes During Cardiac Rehabilitation: A Systematic Review and Meta-Analysis

Abstract

Background: Cardiac rehabilitation is offered to individuals after cardiac events to aid recovery and reduce the likelihood of further cardiac illness. However, patient participation remains suboptimal and the provision of high quality care to an expanding population of patients with chronic heart conditions is becoming increasingly difficult. A systematic review and meta-analysis was conducted to determine the effect of telephone support interventions compared with standard postdischarge care on coronary artery disease patient outcomes. Methods: The Cochrane Library, MEDLINE, EMBASE, and CINAHL were searched and randomized controlled trials that directly compared telephone interventions with standard post-discharge care in adults following a myocardial infarction or a revascularization procedure were included. Study selection, data extraction and quality assessment were completed independently by two reviewers. Where appropriate, outcome data were combined and analyzed using a random effects model. For each dichotomous outcome, odds ratios (OR) and 95% confidence intervals (CI) were derived for each outcome. For continuous outcomes, weighted mean differences (WMD) and standardized mean differences (SMD) and 95% CI were calculated. Results: 26 studies met the inclusion criteria. No difference was observed in mortality between the telephone group and the group receiving standard care OR 1.12 (0.71, 1.77). The intervention was significantly associated with fewer hospitalizations than the comparison group OR 0.62 (0.40, 0.97). Significantly more participants in the telephone group stopped smoking OR 1.32 (1.07, 1.62); had lower systolic blood pressure WMD 20.22 (20.40, 20.04); lower depression scores SMD 20.10 (20.21, 20.00); and lower anxiety scores SMD 20.14 (20.24, 20.04). However, no significant difference was observed for lowdensity lipoprotein levels WMD 20.10 (20.23, 0.03). Conclusions: Compared to standard post-discharge care, regular telephone support interventions may help reduce feelings of anxiety and depression as well as, improve systolic blood pressure control and the likelihood of smoking cessation.

Educational program for coronary artery disease patients: results after one year

“…Telephone support can help provide specialized preventive care to patients with more difficult access to services, and has the potential of some reduction of the health system burden. This is an important aspect for investigation in future research (18) .…”

“…A recent meta-analysis on the effects of telephone follow-up on the rehabilitation of patients with CAD has shown evidence that support provided by telephone follow-up may lead to anxiety reduction (18) . The study highlighted the need for follow-up studies for periods of 12 months or more, and by taking into account there are important benefits in reducing anxiety, which may contribute to the reduction of cardiac risk and hospitalizations.…”

Implementation of a medication adherence program in senior public housing facilities utilizing pharmacists and health educators

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Information and communication technology-based cardiac rehabilitation homecare programs

“…Studies were able to demonstrate similar significant improvements in exercise capacity in home-based CR as that of the center-based CR programs. 42,43 A recent systematic review and meta-analysis, 52 however, showed that telephone-supported CR interventions for coronary heart disease patients was limited to reducing certain risk factors such as anxiety and depression, while improving systolic BP and the likelihood of smoking cessation. Furthermore, telephone-supported CR interventions also have their drawbacks, as possible labor-intensive conversations are expensive; this is supported by less conclusive cost-effectiveness reports of such programs than by reports that are focused on clinical effectiveness.…”