A review of caregiver distress and coronary artery disease: prevalence, risk, outcomes, and management
Authors: Bouchard K , Dans M , Quinlan B , Higdon G , Tulloch H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Witnessing a loved one experience an acute, life-threatening event may prompt distress among those caring for patients with coronary artery disease. Furthermore, medical management and lifestyle behaviour change is often required of the patient with assistance from the caregiver, which may prompt feelings of caregiver burden. Reviews have highlighted the risks and rewards of caregiving in the heart failure context but there has been no synthesis of the literature on caregiver distress in other cardiac patient populations. A summary of accumulated knowledge is required to estimate caregivers’ potential risk, identify potentially efficacious practices and programming to respond to this risk, and highlight gaps in the research.

Purpose
This narrative review synthesizes existing research on distress in caregivers of patients who experienced an acute coronary syndrome (ACS) and/or coronary revascularization (PCI/CABG).

Methods
Eligibility criteria included English, primary studies (published between 2002-2022) using quantitative research methods that investigated caregiver distress (defined as anxiety, depression, quality of life, perceived burden and strain) as a descriptive, predictive, or outcome variable. Patients must have experienced an ACS or PCI/CABG.

Results
Overall, 31 articles met the eligibility criteria (20 observational; 11 intervention). The sample sizes ranged from 33-460 caregivers, with a total of 4943 caregivers (71.3% female; 80% spouses). Caregiver distress varied widely (6-67% of the samples had distress scores &gt; cut offs). Sociodemographic correlates of worse caregiver distress were younger age and less education. Sex-and-gender specific analyses were seldom conducted. Caregiver distress was higher in those with poorer preventative health behaviours, lower quality of life, passive coping strategies, and reduced caregiver competence. Predictors of caregiver distress were patients’ depression symptoms, poor relationship quality/marital satisfaction, less optimism, and fear of the patient’s illness progression. A patient’s increased access to informational and emotional support reduced caregiver distress; patients’ elevated levels of anxiety and depression were associated with greater caregiver distress. Interventions were broadly categorized as educational, psychosocial, and cardiac rehabilitation. Most interventions were brief (&lt;6 sessions) with follow-ups ranging from three days to two-years. In general, 70% of interventions yielded positive changes in caregiver distress.

Conclusions
This review synthesized contemporary data on distress in caregivers of patients with CAD. These results are far from definitive, however, as there is heterogeneity in study samples, measurements used, and timing of assessments and programming. Further advancement in caregiving science and clinical care is required to adequately understand and respond to the needs of caregivers throughout the patient’s illness trajectory.