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Review
. 2014 Feb 1:14:14.
doi: 10.1186/1471-2261-14-14.

Impact of self-management interventions on stable angina symptoms and health-related quality of life: a meta-analysis

Michael McGillion  1 , Sheila O'Keefe-McCarthy, Sandra L Carroll, J Charles Victor, Tammy Cosman, Allison Cook, John G Hanlon, E Marc Jolicoeur, Noorin Jamal, Robert McKelvie, Heather M Arthur
Affiliations
Review

Impact of self-management interventions on stable angina symptoms and health-related quality of life: a meta-analysis

Michael McGillion et al. BMC Cardiovasc Disord. .

Abstract

Background: Chronic stable angina (CSA) has a major negative impact on health-related quality of life (HRQL) including poor general health status, psychological distress, and inability to self-manage.

Methods: We used meta-analysis to assess the effectiveness of self-management interventions for improving stable angina symptoms, HRQL and psychological well-being. Nine trials, involving 1,282 participants in total, were included. We used standard inverse-variance random-effects meta-analysis to combine the trials. Heterogeneity between trials was evaluated using chi-square tests for the tau-squared statistic and quantified using the I2 statistic.

Results: There was significant improvement in the frequency of angina symptoms (Seattle Angina Questionnaire [SAQ], symptom diary) across trials, standardized mean difference (SMD): 0.30 (95% Confidence interval [CI] 0.14, 0.47), as well as reduction in the use of sublingual (SL) nitrates, SMD: -0.49 (95% CI -0.77, -0.20). Significant improvements for physical limitation (SAQ), SMD: 0.38 (95% CI 0.20, 0.55) and depression scores (Hospital Anxiety and Depression Scale), SMD: -1.38 (95% CI -2.46, -0.30) were also found. The impact of SM on anxiety was uncertain due to statistical heterogeneity across trials for this outcome, I2 = 98%. SM did not improve other HRQL dimensions including angina stability, disease perception, and treatment satisfaction.

Conclusions: SM interventions significantly improve angina frequency and physical limitation; they also decrease the use of SL nitrates and improve depression in some cases. Further work is needed to make definitive conclusions about the impact of SM on cardiac-specific anxiety.

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Figures

Figure 1
Figure 1
Risk of bias assessment of included trials expressed as yes/no/unclear.
Figure 2
Figure 2
Risk of bias assessment of included trials expressed as percentage.
Figure 3
Figure 3
Comparison of SM versus usual care, outcome angina frequency.
Figure 4
Figure 4
Comparison of SM versus usual care, outcome SL nitrate use.
Figure 5
Figure 5
Comparison of SM versus usual care, outcome angina stability (AS).
Figure 6
Figure 6
Comparison of SM versus usual care, outcome physical limitation (PL).
Figure 7
Figure 7
Comparison of SM versus usual care, outcome disease perception (DP).
Figure 8
Figure 8
Comparison of SM versus usual care, outcome treatment satisfaction (TS).
Figure 9
Figure 9
Comparison of SM versus usual care, outcome anxiety (HADS-A).
Figure 10
Figure 10
Sensitivity analysis: comparison of SM versus usual care removing the influence of data from Furze et al.[20], outcome anxiety (HADS-A).
Figure 11
Figure 11
Comparison of SM versus usual care, outcome depression (HADS-D).
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