Effectiveness of nonpharmacological secondary prevention of coronary heart disease
Creators: name: Müller-Riemenschneider, Falk
name: Meinhard, Charlotte
name: Damm, Kathrin
name: Vauth, Christoph
name: Bockelbrink, Angelina
name: Greiner, Wolfgang
name: Willich, Stefan N.
Publisher: name: London : SAGE Publications Ltd.
Year: 2010
Subjects: subject: coronary heart disease
subject: meta-analysis
subject: secondary prevention
subject: systematic review
subject: unsaturated fatty acid
subject: article
subject: cardiovascular risk
subject: diet supplementation
subject: diet therapy
subject: dietary fiber
subject: exercise
subject: follow up
subject: genetic heterogeneity
subject: health program
subject: home care
subject: hospital care
subject: human
subject: intermethod comparison
subject: intervention study
subject: ischemic heart disease
subject: low fat diet
subject: medical research
subject: meta analysis (topic)
subject: mortality
subject: outcome assessment
subject: priority journal
subject: psychosocial care
subject: quality of life
subject: randomized controlled trial (topic)
subject: sensitivity analysis
subject: smoking cessation
subject: stress management
subject: therapy effect
subject: treatment indication
subject: Coronary Disease
subject: Diet
subject: Exercise
subject: Humans
subject: Psychotherapy
subject: Quality of Life
subject: Recurrence
subject: Risk Assessment
subject: Risk Factors
subject: Risk Reduction Behavior
subject: Secondary Prevention
subject: Smoking Cessation
subject: Treatment Outcome
subject: Dewey Decimal Classification::600 | Technik::610 | Medizin, Gesundheit

description: 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. © 2010 The European Society of Cardiology.