Self-care interventions in patients with coronary artery disease: room for improvement
Authors: Westland H , Jaarsma T , Riegel B , Iovino P , Henry Osokpo O , Stawnychy M , Tarbi E 
Published: November 2020

Abstract

After a coronary artery event it is vital that patients perform self-care Self-care can be defined broadly as a process of maintaining health through treatment adherence and health-promoting practices (self-care maintenance), behavior and condition monitoring (self-care monitoring), and managing signs and symptoms when they occur (self-care management). For patients with coronary artery disease (CAD) essential self-care activities include adherence to medication, risk-factor management, symptom monitoring and preventive behavior. To advance the field of self-care in CAD patients, it is important to understand which self-care elements are currently addressed in interventions studies. The purpose of this study was to describe which behaviors are emphasized in self-care interventions for patients with CAD.

Methods
We conducted a systematic review of self-care interventions in chronic diseases. Four databases were search for randomized controlled trials with allocation to an intervention or to usual care or another intervention in adults with nine major symptomatic chronic conditions, one of which was coronary artery disease. Between 2008 and 2019 there were 9309 potential articles addressing self-care in chronic disease. After duplicates were removed and titles and abstracts were reviewed, 166 full-text articles on CAD studies evaluating a self-care intervention were assessed for eligibility and 15 studies remained after further assessment.

Results
Almost all studies (80%) in CAD patients included all three components of self-care (self-care maintenance, monitoring and management) in their interventions. Self-care maintenance behaviors addressed in these studies were mainly related to physical activity (73%) diet (60%) and medication management (33%) Another 40% included a psychosocial component, but only 4 studies (26%) were specially targeted at smoking behavior. With regard to self-care monitoring, most (60%) included monitoring of their physical activity level and 26% monitoring of symptoms. Self-care management behaviours were addressed rarely, but when addressed, focused on adapting activity level (60%), adapting diet (27%), medication changes (20%) and stress reduction (20%). Goal setting (60%), problem solving (40%) and feedback (33%) were the behavioural change techniques that were used most often to promote self-care. Only 1 study mentioned the use of social support. One study used reminders.

Conclusions
Most interventions that are tested to improve outcomes in patients with CAD address self-care maintenance, monitoring, management. The behavioural change techniques used are limited. There is a large variation in which behaviours are emphasized in research studies and the focus is primarily on changing traditional lifestyle factors, but not all life-style factors are addressed adequately in the interventions.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Australian Catholic University