Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: systematic review.

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Abstract

OBJECTIVE: This systematic review of recent randomized trials was conducted to determine if cardiovascular nursing interventions improve outcomes in patients with coronary artery disease (CAD) and/or heart failure. METHODS: Randomized controlled trials of nursing interventions in patients with CAD or heart failure published from January 2000 to December 2008 were eligible. Pilot studies and trials with greater than 25% attrition with no intention-to-treat analyses were excluded. Study characteristics and results were extracted and trials were graded for methodological quality. RESULTS: A total of 2,039 citations from electronic databases were identified; 55 articles were eligible for inclusion. The primary intervention strategy was education plus behavioral counseling and support (65% of interventions) using a combination of intervention modes. More than half of the trials (57%) reported statistically significant results in at least 1 outcome of blood pressure, lipids, physical activity, dietary intake, cigarette smoking, weight loss, healthcare utilization, mortality, quality of life, and psychosocial outcomes. However, there were no consistent relationships observed between intervention characteristics and the effects of interventions. The average measure of study quality was 2.8 (possible range, 0-4, with higher score equaling higher quality). CONCLUSION: Most trials reviewed demonstrated a beneficial impact of nursing interventions for secondary prevention in patients with CAD or heart failure. However, the optimal combination of intervention components, including strategy, mode of delivery, frequency, and duration, remains unknown. Establishing consensus regarding outcome measures, inclusion of adequate, representative samples, along with cost-effectiveness analyses will promote translation and adoption of cost-effective nursing interventions.

Original languageEnglish (US)
Pages (from-to)207-220
Number of pages14
JournalThe Journal of cardiovascular nursing
Volume25
Issue number3
StatePublished - May 2010

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Secondary Prevention
Coronary Artery Disease
Nursing
Heart Failure
Cardiovascular Nursing
Intention to Treat Analysis
Cost-Benefit Analysis
Counseling
Weight Loss
Consensus
Randomized Controlled Trials
Smoking
Quality of Life
Outcome Assessment (Health Care)
Databases
Exercise
Blood Pressure
Delivery of Health Care
Lipids
Education

ASJC Scopus subject areas

  • Medicine(all)
  • Advanced and Specialized Nursing
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: systematic review.",
abstract = "OBJECTIVE: This systematic review of recent randomized trials was conducted to determine if cardiovascular nursing interventions improve outcomes in patients with coronary artery disease (CAD) and/or heart failure. METHODS: Randomized controlled trials of nursing interventions in patients with CAD or heart failure published from January 2000 to December 2008 were eligible. Pilot studies and trials with greater than 25{\%} attrition with no intention-to-treat analyses were excluded. Study characteristics and results were extracted and trials were graded for methodological quality. RESULTS: A total of 2,039 citations from electronic databases were identified; 55 articles were eligible for inclusion. The primary intervention strategy was education plus behavioral counseling and support (65{\%} of interventions) using a combination of intervention modes. More than half of the trials (57{\%}) reported statistically significant results in at least 1 outcome of blood pressure, lipids, physical activity, dietary intake, cigarette smoking, weight loss, healthcare utilization, mortality, quality of life, and psychosocial outcomes. However, there were no consistent relationships observed between intervention characteristics and the effects of interventions. The average measure of study quality was 2.8 (possible range, 0-4, with higher score equaling higher quality). CONCLUSION: Most trials reviewed demonstrated a beneficial impact of nursing interventions for secondary prevention in patients with CAD or heart failure. However, the optimal combination of intervention components, including strategy, mode of delivery, frequency, and duration, remains unknown. Establishing consensus regarding outcome measures, inclusion of adequate, representative samples, along with cost-effectiveness analyses will promote translation and adoption of cost-effective nursing interventions.",
author = "Allen, {Jerilyn K.} and Dennison-Himmelfarb, {Cheryl Renee}",
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N2 - OBJECTIVE: This systematic review of recent randomized trials was conducted to determine if cardiovascular nursing interventions improve outcomes in patients with coronary artery disease (CAD) and/or heart failure. METHODS: Randomized controlled trials of nursing interventions in patients with CAD or heart failure published from January 2000 to December 2008 were eligible. Pilot studies and trials with greater than 25% attrition with no intention-to-treat analyses were excluded. Study characteristics and results were extracted and trials were graded for methodological quality. RESULTS: A total of 2,039 citations from electronic databases were identified; 55 articles were eligible for inclusion. The primary intervention strategy was education plus behavioral counseling and support (65% of interventions) using a combination of intervention modes. More than half of the trials (57%) reported statistically significant results in at least 1 outcome of blood pressure, lipids, physical activity, dietary intake, cigarette smoking, weight loss, healthcare utilization, mortality, quality of life, and psychosocial outcomes. However, there were no consistent relationships observed between intervention characteristics and the effects of interventions. The average measure of study quality was 2.8 (possible range, 0-4, with higher score equaling higher quality). CONCLUSION: Most trials reviewed demonstrated a beneficial impact of nursing interventions for secondary prevention in patients with CAD or heart failure. However, the optimal combination of intervention components, including strategy, mode of delivery, frequency, and duration, remains unknown. Establishing consensus regarding outcome measures, inclusion of adequate, representative samples, along with cost-effectiveness analyses will promote translation and adoption of cost-effective nursing interventions.

AB - OBJECTIVE: This systematic review of recent randomized trials was conducted to determine if cardiovascular nursing interventions improve outcomes in patients with coronary artery disease (CAD) and/or heart failure. METHODS: Randomized controlled trials of nursing interventions in patients with CAD or heart failure published from January 2000 to December 2008 were eligible. Pilot studies and trials with greater than 25% attrition with no intention-to-treat analyses were excluded. Study characteristics and results were extracted and trials were graded for methodological quality. RESULTS: A total of 2,039 citations from electronic databases were identified; 55 articles were eligible for inclusion. The primary intervention strategy was education plus behavioral counseling and support (65% of interventions) using a combination of intervention modes. More than half of the trials (57%) reported statistically significant results in at least 1 outcome of blood pressure, lipids, physical activity, dietary intake, cigarette smoking, weight loss, healthcare utilization, mortality, quality of life, and psychosocial outcomes. However, there were no consistent relationships observed between intervention characteristics and the effects of interventions. The average measure of study quality was 2.8 (possible range, 0-4, with higher score equaling higher quality). CONCLUSION: Most trials reviewed demonstrated a beneficial impact of nursing interventions for secondary prevention in patients with CAD or heart failure. However, the optimal combination of intervention components, including strategy, mode of delivery, frequency, and duration, remains unknown. Establishing consensus regarding outcome measures, inclusion of adequate, representative samples, along with cost-effectiveness analyses will promote translation and adoption of cost-effective nursing interventions.

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