TY - JOUR

T1 - Effectiveness of nonpharmacological secondary prevention of coronary heart disease

AU - Müller-Riemenschneider, Falk

AU - Meinhard, Charlotte

AU - Damm, Kathrin

AU - Vauth, Christoph

AU - Bockelbrink, Angelina

AU - Greiner, Wolfgang

AU - Willich, Stefan N.

N1 - Funding Information: This study was commissioned and in part funded by the German Agency for Health Technology Assessment at the German Institute of Medical Documentation and Information http://(DAHTA@DIMDI ), a subsidiary of the German Federal Ministry of Health. Funding organisations or sponsors had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review or approval of the manuscript. There is no conflict of interest.

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Aim: To summarize the current evidence with regard to the effectiveness of nonpharmacological secondary prevention strategies of coronary heart disease (CHD) and to investigate the comparative effectiveness of interventions of different categories, specific intervention components and the effectiveness in patient subgroups. Methods: A structured search of databases and manual search were conducted. Clinical trials and meta-analyses published between January 2003 and September 2008 were included if they targeted adults with CHD, had a follow-up of at least 12 months, and reported mortality, cardiac events or quality of life. Two researchers assessed eligibility and methodological quality, in which appropriate, pooled effect estimates were calculated and tested in sensitivity analyses. Results: Of 4798 publications 43 met the inclusion criteria. Overall study quality was satisfactory, but only about half of the studies reported mortality. Follow-up duration varied between 12 and 120 months. Despite substantial heterogeneity, there was strong evidence of intervention effectiveness overall. The evidence for exercise and multimodal interventions was more conclusive for reducing mortality, whereas psychosocial interventions seemed to be more effective in improving the quality of life. Rigorous studies investigating dietary and smoking cessation interventions, specific intervention components and important patient subgroups, were scarce. Conclusion: Nonpharmacological secondary prevention is safe and effective, with exercise and multimodal interventions reducing mortality most substantially. There is a lack of studies concerning dietary and smoking cessation interventions. In addition, intervention effectiveness in patient subgroups and of intervention components could not be evaluated conclusively. Future research should investigate these issues in rigorous studies with appropriate follow-up duration to improve the current poor risk factor control of CHD patients.

AB - Aim: To summarize the current evidence with regard to the effectiveness of nonpharmacological secondary prevention strategies of coronary heart disease (CHD) and to investigate the comparative effectiveness of interventions of different categories, specific intervention components and the effectiveness in patient subgroups. Methods: A structured search of databases and manual search were conducted. Clinical trials and meta-analyses published between January 2003 and September 2008 were included if they targeted adults with CHD, had a follow-up of at least 12 months, and reported mortality, cardiac events or quality of life. Two researchers assessed eligibility and methodological quality, in which appropriate, pooled effect estimates were calculated and tested in sensitivity analyses. Results: Of 4798 publications 43 met the inclusion criteria. Overall study quality was satisfactory, but only about half of the studies reported mortality. Follow-up duration varied between 12 and 120 months. Despite substantial heterogeneity, there was strong evidence of intervention effectiveness overall. The evidence for exercise and multimodal interventions was more conclusive for reducing mortality, whereas psychosocial interventions seemed to be more effective in improving the quality of life. Rigorous studies investigating dietary and smoking cessation interventions, specific intervention components and important patient subgroups, were scarce. Conclusion: Nonpharmacological secondary prevention is safe and effective, with exercise and multimodal interventions reducing mortality most substantially. There is a lack of studies concerning dietary and smoking cessation interventions. In addition, intervention effectiveness in patient subgroups and of intervention components could not be evaluated conclusively. Future research should investigate these issues in rigorous studies with appropriate follow-up duration to improve the current poor risk factor control of CHD patients.

KW - coronary heart disease

KW - meta-analysis

KW - secondary prevention

KW - systematic review

UR - http://www.scopus.com/inward/record.url?scp=79851511371&partnerID=8YFLogxK

U2 - 10.1097/HJR.0b013e32833a1c95

DO - 10.1097/HJR.0b013e32833a1c95

M3 - Article

AN - SCOPUS:79851511371

VL - 17

SP - 688

EP - 700

JO - European Journal of Cardiovascular Prevention and Rehabilitation

JF - European Journal of Cardiovascular Prevention and Rehabilitation

SN - 1741-8267

IS - 6

ER -