A systematic review, meta-analysis, and meta-regression of patient education for secondary prevention in patients with coronary heart disease: impact on psychological outcomes

Eur J Cardiovasc Nurs. 2022 Oct 14;21(7):643-654. doi: 10.1093/eurjcn/zvac001.


Background: Patient education is a cardiac rehabilitation core component and is associated with improvements in self-management of patients with coronary heart disease (CHD). However, the efficacy of such interventions on psychosocial outcomes and relative impact of duration is less clear.

Objectives: This study aimed to assess the efficacy of patient education for secondary prevention related to behaviour change and risk factor modification on psychological outcomes in CHD patients.

Design: A systematic review and meta-analysis.

Data sources: PsycINFO, CINAHL, Embase, EmCare, MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials were searched from inception to February 2021.

Eligibility criteria for study selection: Randomized controlled trials (RCTs) evaluating patient education in CHD patients, or following myocardial infarction, or revascularization compared with usual care were identified. Outcomes included depression and anxiety at <6 and 6-12 months of follow-up.

Results: A total of 39 RCTs and 8748 participants were included. Patient education significantly improved participants' depressive symptoms at <6 (SMD -0.82) and 6-12 months (SMD -0.38) of follow-up and anxiety level at <6 (SMD -0.90), and 6-12 months (SMD -0.32) of follow-up. Patient education also reduced the risk for having clinical depression by 35% and anxiety by 60%. Longer patient education of ≥3 months, resulted in more improvement in depressive symptoms at 6-12 months (coefficient -0.210) compared to shorter duration.

Conclusions: Patient education for secondary prevention reduces anxiety and depressive symptoms in CHD patients. Regardless of intensity, longer patient education improves depression more than short duration. More information is needed on the relative impact of other intervention components.

Data registration: PROSPERO (CRD42020200504).

Keywords: Anxiety; Coronary heart disease; Depression; Meta-analysis; Patient education; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anxiety
  • Coronary Disease* / complications
  • Coronary Disease* / prevention & control
  • Coronary Disease* / psychology
  • Depression
  • Humans
  • Patient Education as Topic
  • Quality of Life*
  • Secondary Prevention