Figures
Abstract
Background
Cardiac rehabilitation is offered to individuals after cardiac events to aid recovery and reduce the likelihood of further cardiac illness. However, patient participation remains suboptimal and the provision of high quality care to an expanding population of patients with chronic heart conditions is becoming increasingly difficult. A systematic review and meta-analysis was conducted to determine the effect of telephone support interventions compared with standard post-discharge care on coronary artery disease patient outcomes.
Methods
The Cochrane Library, MEDLINE, EMBASE, and CINAHL were searched and randomized controlled trials that directly compared telephone interventions with standard post-discharge care in adults following a myocardial infarction or a revascularization procedure were included. Study selection, data extraction and quality assessment were completed independently by two reviewers. Where appropriate, outcome data were combined and analyzed using a random effects model. For each dichotomous outcome, odds ratios (OR) and 95% confidence intervals (CI) were derived for each outcome. For continuous outcomes, weighted mean differences (WMD) and standardized mean differences (SMD) and 95% CI were calculated.
Results
26 studies met the inclusion criteria. No difference was observed in mortality between the telephone group and the group receiving standard care OR 1.12 (0.71, 1.77). The intervention was significantly associated with fewer hospitalizations than the comparison group OR 0.62 (0.40, 0.97). Significantly more participants in the telephone group stopped smoking OR 1.32 (1.07, 1.62); had lower systolic blood pressure WMD −0.22 (−0.40, −0.04); lower depression scores SMD −0.10 (−0.21, −0.00); and lower anxiety scores SMD −0.14 (−0.24, −0.04). However, no significant difference was observed for low-density lipoprotein levels WMD −0.10 (−0.23, 0.03).
Citation: Kotb A, Hsieh S, Wells GA (2014) The Effect of Telephone Support Interventions on Coronary Artery Disease (CAD) Patient Outcomes during Cardiac Rehabilitation: A Systematic Review and Meta-Analysis. PLoS ONE 9(5): e96581. https://doi.org/10.1371/journal.pone.0096581
Editor: Yiru Guo, University of Louisville, United States of America
Received: February 17, 2014; Accepted: April 8, 2014; Published: May 5, 2014
Copyright: © 2014 Kotb et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This research was funded by an Ontario Graduate Scholarship. The funders had no role in study design, data collection and analysis, decision to publish, or the preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Cardiac rehabilitation (CR) is offered to individuals after cardiac events to aid recovery and reduce the likelihood of further cardiac illness. They have been previously shown to improve physical health as well as decrease subsequent morbidity and mortality through exercise, education, behavior change, counseling and other strategies aimed at targeting traditional risk factors for cardiovascular disease [1]–[6]. Despite these benefits however, patient participation in these programs remains suboptimal [7].
Some evidence suggests that interventions involving motivational communications delivered through letters, telephone calls and home visits may increase the uptake of cardiac rehabilitation [8].This offers promise as the provision of high quality care to an expanding population of older patients with chronic heart conditions becomes increasingly difficult. On the other hand, patients may be unwilling or unable to make frequent clinic attendance due to financial, transport or disability constraints [9].
To date, much of the evidence available has been focused on examining the effect of complex and multifactorial telemedicine interventions on heart failure (HF) patients. HF is a complex debilitating syndrome that results from a cardiac dysfunction that impairs the ability of the ventricle to fill with or eject blood[10]. More recently however, more basic telephone support interventions have been adapted for use in coronary artery disease (CAD) patient populations CAD is one of the most common forms of heart disease that results from an impedance or blockage of one or more arteries that supply blood to the heart [11]–[12].
Previous reports have examined the impact of multifaceted interventions on chronic diseases in general. When multifaceted interventions are examined, it becomes difficult to determine specifically which method of telemedicine appears most effective for this particular patient population. The aim of this systematic review and meta-analysis is to examine the literature on the impact of receiving structured telephone support, during cardiac rehabilitation, on clinical events, cardiac risk factors and patient reported outcomes in individuals with CAD compared to receiving usual follow-up care alone. The research questions addressed were: (1) What impact does structured telephone support (STS) have on mortality and hospitalization? (2) What impact does STS have on controlling risk factors such as smoking, systolic blood pressure, and low-density lipoprotein? (3) What does STS have on patient reported outcomes such as anxiety and depression?
Methods
Data Sources and Searches
Relevant randomized controlled trials published before September 2012 were identified by searching the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database (HTA) on The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, and the Web of Knowledge. Language restrictions were not applied to any of the searches. Bibliographies of included trials were examined to identify other potentially relevant studies.
Study Selection
Randomized controlled trials were included if they directly compared the impact of telephone-delivered post-discharge interventions with standard care at discharge in adults (18 years or older) who had experienced a myocardial infarction (MI), a revascularization procedure (coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA)), and those with angina, or angiographically defined coronary heart disease. The primary outcome was all-cause hospitalization. Secondary outcomes included all-cause mortality, depression, anxiety as well as measures taken to reduce the risk of further cardiac illness such as smoking cessation, reducing systolic blood pressure, and low-density lipoprotein cholesterol levels.
In the first phase of screening, the titles and abstracts of all identified citations were screened by two independent reviewers (AK and SC). In the second phase of screening, full manuscripts were retrieved and screened by two independent reviewers on the basis of our predefined patient population, intervention, comparison, outcomes and study design of interest. Disagreements were resolved through discussion or through adjudication by a third reviewer (GW).
Data Extraction and Quality Assessment
For each included paper, one review author (AK) extracted data and a second author (SC) checked the extracted data and disagreements were resolved by discussion between the two review authors. If no agreement could be reached, a third author (GW) was required for adjudication.
The SIGN-50 checklist and the Cochrane Collaboration's tool for assessing risk of bias (ROB) were used to evaluate the methodological quality of included trials. Two independent reviewers conducted the quality assessments (AK and SC). Disagreements between reviewers were resolved by discussion or through adjudication by a third reviewer (GW).
Data Synthesis and Analysis
The primary analysis was a comparison of telephone follow-up with usual care. Heterogeneity amongst included studies was explored qualitatively by comparing the characteristics of included studies, visual inspection of forest plots and quantitatively using Cochrane's Q test and I2 statistic. For continuous data (using the same measuring instrument) the weighted mean difference (WMD) and 95% confidence intervals (CI) are reported. Where the studies have used different instruments to measure the same conceptual outcome, the standardized mean difference (SMD) is reported. In studies that report dichotomous data, the odds ratios (OR) or risk ratios (RR) and confidence intervals (CI) are reported. To account for heterogeneity and take a more conservative approach, the analyses were carried out using the random-effects model are presented. Sensitivity analyses using fixed effect models were conducted for comparison.
Results
Search results
The electronic search conducted yielded a total of 1,538 titles. The reference lists of studies later included were hand-searched and resulted in the selection of 53 studies for additional screening. After duplicates were removed, the titles and abstracts of 1,235 studies were screened. A total of 1,075 studies were excluded and 160 studies were retrieved for possible inclusion. After examining their full texts, 26 studies were included [13]–[38] and 134 were excluded. The study selection process and the reasons for exclusion are summarized in the PRISMA flow diagram shown in Figure 1.
Description of studies
All included randomized controlled trials (4,081 participants) compared a telephone intervention designed to improve cardiac patients' outcomes directly to standard post-discharge care. Nine of the included studies were conducted in Canada [13], [16], [20], [30], [31], [32], [33], [34], [35] 8 in Australia[17], [25]–[29], [37], [38], 5 in the United States of America[14], [21]–[23], [38] 3 in Europe [18], [19], [24] and 1 in Iran [15]. Thirteen studies had longer than 6 months of follow-up [19], [21], [22], [24], [25], [26], [28], [29], [30], [31]–[33], [38]. Seven studies reported less than 6 months of follow-up [15]–[17], [20], [27], [34], [35] and 6 reported outcomes at 6 months [13], [14], [18], [23], [36], [37]. Sample sizes varied considerably across studies (range: 59 to 792) as well as the number of calls made to participants (range: 3 to 24).
Of the 26 included studies, 8 studies recruited patients diagnosed with Acute Coronary Syndrome [14], [21], [23], [25]–[29] 8 recruited patients who had undergone revascularization patients [13], [15], [16], [20], [31]–[33], [37] 4 studies recruited patients diagnosed with a myocardial infarction [18], [19], [34], [38] and 6 recruited any patients diagnosed with coronary artery disease [17], [22], [24], [30], [35], [36]. Ten studies described their patient populations as having received some degree of cardiac rehabilitation [13], [15], [17], [19], [24], [31]–[33], [36], [37]. Of those 10 studies, only 7 provided the proportion of patients who participated in CR (range: from 32% to 100%) [17], [24], [31]–[33], [36], [37]. Five studies described their patient populations as not accessing CR [25]–[29] and the remaining 11 studies did not provide detail regarding how much of their included participants also took part in cardiac rehabilitation [14], [16], [18], [20]–[23], [30], [34], [35], [38].
The frequency of calls made varied between 3–6 times in fourteen studies and was greater than 6 calls in five studies. In 8 studies, the frequency of the intervention was not detailed [18], [19], [22], [28], [34], [35], [36], [38]. In most studies, the telephone support intervention was delivered by a clinician with nurses being the most commonly reported delivery personnel. The second most common professional delivering the intervention was an exercise specialist. This occurred when the interventions' main component was exercise [13], [31]–[33]. In one instance, when the intervention was focused primarily on lowering cholesterol levels, the intervention was delivered by a dietitian [37]. In one instance when the intervention was designed to address a multitude of risk factors, the intervention was delivered by a health educator. Further detail is available in Table 1 regarding the design of each included study, the type of patients included, and the interventions compared.
Risk of bias in included studies
Using the SIGN-50 quality assessment tool for randomized controlled trials, 14 studies were considered to be of high quality [13], [20], [26]–[37] 11 were considered to be of acceptable quality[14], [16]–[19], [21]–[25], [38] and 1 was considered to be low [15] (see Table 1). A summary of the risk of bias of included studies is described in Figure 2. The risk of bias assessment of each study is detailed in Figure S1. Funnel plots were only considered for the outcome of mortality due to the fact that the number of studies was deemed sufficient to produce a reliable assessment (Figure S2). No considerable asymmetry was apparent.
Structured telephone support interventions versus usual care.
Figure 3 provides a summary of the intervention's main effects compared to usual care for the following outcomes of interest: all-cause mortality, all-cause hospitalization, smoking cessation, and depression. Further detail on the meta-analysis of the following outcomes: systolic blood pressure, low-density lipoprotein levels, and anxiety are available in Figures S3-S8.
Clinical events
Data on all-cause mortality was available and considered appropriate to be combined across 11 studies (Figure 3). Five studies were conducted in N. America, 4 in Australia and 2 in Europe. The quality was judged to be high for 5 studies and acceptable for 6. With the exception of one study, all included studies followed patients for at least 6 months. Four studies described their included patient population as having had an acute myocardial infarction, 4 as having acute coronary syndrome and 3 as having had a revascularization procedure. In 5 studies, a significant proportion of the included population participated in a cardiac rehabilitation program. In the remaining six studies, the participation of patients in a cardiac rehabilitation program was not described. In 7 of the studies the intervention was delivered by a nurse who offered support and education on topics that included risk factor control and improved symptom recognition. In the remaining 4 studies, the professionals delivering the intervention included health educators, pharmacists, dietitians, and exercise specialist. When the intervention was delivered by an exercise specialist the intervention focused more on physical activity in the period following an event. Where the intervention was delivered by a dietitian or pharmacist the focus shifted more towards lipid control. The I2 = 0% and the overall effect estimate found showed no difference in the odds of mortality between the intervention and comparison group [OR 1.12 95% CI (0.71, 1.77)].
A total of 4 studies reported on hospitalization after discharge (Figure 3). Three of the four studies were conducted in Canada and one was conducted in Norway. Three of the four studies were considered to be of high quality and the fourth study was judged to be of acceptable quality. Heterogeneity was further examined according to the PICO statement of individual trials. In three out of the four studies, the majority of the CAD patient population had undergone a revascularization procedure. With the exception of the study by Smith (2011), three out of the four studies involved telephone follow-up carried out by a nurse that focused on the provision of support and education. Furthermore, only the study by Smith (2011) included a large portion of individuals who were participating in a cardiac rehabilitation program. The statistical measure of heterogeneity was low (I2 = 15%) and the overall effect estimate indicated significantly lower odds of hospitalization [OR 0.62 95% CI (0.40, 0.97)] in the telephone group. It is important to note however, that when a sensitivity analysis was conducted with and without the most outlying study, Beckie (1989), the significant effect was no longer found [OR 0.68 95% CI (0.45, 1.01)].
Modifiable risk factors.
A total of 6 studies reported data on smoking cessation (Figure 3). Two studies were conducted in N. America, 2 in Europe and 2 in Australia. All six studies were considered to be of either acceptable or high quality. The follow-up period in all six studies was 6 or more months. In all six studies, the patient population was described as individuals recovering from either an AMI or CABG procedure. In all studies, the intervention was delivered by nurses who took part in coaching, supporting and educating participants. In only two studies, participants were described as having received cardiac rehabilitation. When combined together the overall effect estimate indicated significantly greater odds of smoking cessation in the group receiving the telephone intervention [Risk Ratio 1.32 95% CI (1.07, 1.62)].
Two studies reported data on SBP differences between treatment groups. The follow-up period in both studies was 12 or more months. The study by Mittag (2006) was conducted in Germany and the study by Neubeck (2011) was conducted in Australia. The quality of both studies was considered to be acceptable. Both studies included acute CAD patients and both telephone follow-up interventions were delivered by nurses and focused on risk factor reduction. The I2 = 0% and the overall calculated WMD for SBP was significantly lower for the telephone group [WMD −4.22 95% CI (−7.58, −0.85)].
A total of 4 studies reported data regarding the change in LDL levels between treatment groups. In three out of the 4 studies the follow-up period was greater than or equal to 12 months. Two studies were conducted in N. America and two were conducted in Australia. The quality of the studies was considered high in 3 studies and acceptable in 1. Three studies described their patient population as acute coronary syndrome or recovering from a revascularization procedure while one study only broadly defined patients as having coronary heart disease (CHD). The telephone intervention was delivered by a different type of specialist in each study. This included a dietitian, an exercise specialist, a nurse, and a pharmacist. The I2 statistic = 71% when these studies were analyzed together using a random effects model. When only studies of longer than 6 months follow-up were examined, the I2 statistic was reduced to 16% and the overall WMD for LDL was not found to significantly differ between comparison groups (WMD −0.07 [−0.20, 0.05]).
Patient reported outcomes.
In total 5 studies measured and reported on the outcome of depression (Figure 3). In 4 out of the 5 studies, the follow-up period was greater than or equal to 6 months. Two studies were conducted in the United States, two in Australia and one in Germany. The quality of the studies was judged to be acceptable in 4 studies and high in one. In three studies, the patient populations were described to have an acute myocardial infarction (AMI). The patient populations in the remaining two studies were described as having an acute coronary syndrome (ACS) and having undergone was revascularization. In 3 out of 5 studies, a significant portion of the patients received some cardiac rehabilitation services. In 4 out of 5 studies the intervention was delivered by a nurse. In the study that did not involve nurses in the delivery, the intervention was delivered by clinicians. The I2 statistic = 0% and the overall calculated SMD showed a significantly lower (p = 0.04) depression score in the telephone group than the comparison [SMD −0.10 95% CI (−0.21, −0.00)].
Six studies examined the impact of regular telephone follow-up on feelings of anxiety. In 4 out of the 6 studies the follow-up period was greater than or equal to 6 months. Three studies were conducted in N. America, 2 in Australia and 1 in Europe. The quality of the studies was judged to be acceptable in 5 studies and high in one. The patient population was described as having had an AMI or CABG in 5 studies and as ACS in one. In 3 out of 6 studies, a significant portion of the included population received some cardiac rehabilitation services. In 5 out of 6 studies, the nurses delivered the telephone support intervention and in one study the intervention was delivered by a clinician.
Even though the overall calculated SMD indicated that participants in the telephone group had significantly lower anxiety scores than those in the comparison group [SMD −0.29 95% CI (−0.56, −0.01)], the forest plot and I2 (I2 = 81%) indicated that a considerable amount of heterogeneity was evident across studies. The most outlying study by Beckie (1989) had the shortest follow-up having only followed patients for a period of 6 weeks and included CAD patients who were less severe or acutely ill than the patients in other studies. This study was excluded from subsequent analyses that examined studies of longer than 6 weeks of follow-up.
When studies of at least 3 months of follow-up were examined, the analysis included 5 out of the 6 studies. The I2 = 29% and the telephone group was found to have reduced feelings of anxiety than the control group [SMD −0.14 95% CI (−0.24, −0.04)]. This effect remained when studies of 6 or more months of follow-up were examined. This analysis included 4 out of 6 studies and demonstrated that the participants in the telephone intervention group had significantly lower anxiety scores [SMD −0.18 95% CI (−0.30, −0.07)].
Discussion
Many patients with CAD continue to face challenges maintaining their adherence to recommendations for risk reduction such as managing their blood pressure, lowering their low-density lipoprotein levels and abstaining from smoking. A wealth of available evidence also suggests a strong link between increased feelings of depression and anxiety in the period that follows having a coronary event. Together, these continued challenges place individuals with these diseases at an increased risk of further cardiac illness and death. The hypothesis in this review was that the availability of remote monitoring and support services for recovering patients may facilitate access to care and improve patients' outcomes through cardiac risk reduction and improved patient outcomes.
Study participants were mostly males, aged between of 50 and 70 years old, and diagnosed as acute CAD patients defined as having had an MI or a revascularization procedure. With the exception of one study that was conducted in the Middle East, all studies were conducted in either N. America, Europe or Australia. With the exception of one study, the quality of included studies was either high or acceptable and the follow-up period was typically six or more months. The telephone support intervention was typically delivered by a nurse who supported patients and educated them on matters that included cardiac risk reduction and improved symptom recognition. Outcomes considered included clinical events (all-cause mortality and hospitalization), modifiable risk factors (smoking cessation, low-density lipoprotein, and systolic blood pressure), and other patient outcomes (depression and anxiety).
No evidence was found to support any additional benefit as a result of the telephone intervention in terms of a reduction in mortality and level of low-density lipoprotein. These findings were consistent with findings by Neubeck (2009) and Whalley (2011) that showed no strong evidence for reductions in total deaths and the review by Taylor (2010) that found no difference between groups in terms of LDL levels [40], [41].
In this review, participants receiving the telephone intervention did however have significantly fewer hospitalizations. They also experienced significant reductions in systolic blood pressure and were more likely to stop smoking. These findings were similar to those by Barth (2008) and by Neubeck (2009), where telephone support was found to significantly promote smoking cessation in patients with coronary heart disease [11], [39]. Neubeck (2009) also demonstrated that participants in the telephone group had significantly lower systolic blood pressure.
Patients receiving the telephone intervention also had significantly lower depression and anxiety scores were observed in participants who received the telephone intervention. Symptoms of anxiety and depression are commonly experienced by patients with coronary artery diseases (CAD). Depression and anxiety have been previously associated the with increased severity of CAD, the number and length of cardiac-related hospitalizations and all-cause mortality, and can predict greater risk major adverse cardiac events in patients with stable CAD[42]–[44]. Evidence from this systematic review and meta-analysis is therefore in support of conducting a randomized controlled trial of sufficient power and at least 12 months of follow-up to compare the impact associated with the delivery of a regular telephone intervention alongside usual care for monitoring and supporting coronary artery disease patients following an acute cardiac event or revascularization procedure.
This review has several important limitations to consider. Like any systematic review, the strengths of the results depends primarily on the quality and completeness of the data currently available from included studies. Detailed descriptions around participants' attendance and compliance rates for cardiac rehabilitation programs were inadequately reported. This limited how thoroughly this issue can investigated in order to determine if the benefits associated with telephone support are perhaps due to an increased participation in cardiac rehabilitation programs. Furthermore, intensive monitoring can add to more contact with providers and in some instances, more tests. This can occur for an intervention of this sort. Almost all studies were conducted in what are considered to be high-income countries. This in turn limits the generalizability of the findings to settings outside of N. America, Europe and Australia. As is commonly expected, the patient populations varied slightly across included studies. Although only patients with an acute form of coronary artery disease patients who had not advanced to heart failure were considered for this review, included studies described their patients as having either had an acute myocardial infarction, diagnosis of acute coronary syndrome or had undergone a revascularization procedure. A randomized controlled trial that compares the effect of standard care and a telephone support intervention delivered by nurses to aid in the education and counseling of either one of the aforementioned patient groups therefore remains warranted. Even though such resource utilization implications may compromise the benefits associated with telephone support, there was no data available from included studies to address this concern. Further research is needed to examine the cost-effectiveness of this intervention as it compares to the current standard of post-discharge care.
Conclusions
The effectiveness of this simple telephone intervention is of relevance given that most cardiac rehabilitation programs involve one or more of the following: routine monitoring, counseling, and educating. Some of these benefits can be feasibly delivered remotely using telephone technology as a medium. Evidence from this review suggests that telephone support and monitoring appear more effective in reducing certain risk factors than others, physicians may identify, depending on each patient's rehabilitation goals, which patients would be most likely to benefit from the intervention. Through reducing feelings of anxiety and depression, improved control over cardiac risk reduction and fewer hospitalizations, structured telephone support and follow-up can aid in the delivery of specialist preventive care to patients who may otherwise not have access to them and may have the potential to reduce some of the burden on the healthcare system. If hospitalization, anxiety and depression are indeed reduced this would be extremely valuable and possibly cost effective. A larger definitive randomized controlled trial of this intervention targeted to a specific population likely to benefit most is therefore merited.
Supporting Information
Figure S3.
Comparison of structured telephone support and usual care on systolic blood pressure.
https://doi.org/10.1371/journal.pone.0096581.s004
(TIF)
Figure S4.
Comparison of structured telephone support and usual care on low-density lipoprotein.
https://doi.org/10.1371/journal.pone.0096581.s005
(TIF)
Figure S5.
Sensitivity analysis comparing structured telephone support and usual care on LDL levels in studies of at least 6 months of follow-up.
https://doi.org/10.1371/journal.pone.0096581.s006
(TIF)
Figure S6.
Comparison of structured telephone support and usual care on anxiety.
https://doi.org/10.1371/journal.pone.0096581.s007
(TIF)
Figure S7.
Sensitivity analysis comparing structured telephone support and usual care on anxiety in studies of at least 3 months of follow-up.
https://doi.org/10.1371/journal.pone.0096581.s008
(TIF)
Figure S8.
Sensitivity analysis comparing structured telephone support and usual care on anxiety in studies of at least 6 months of follow-up.
https://doi.org/10.1371/journal.pone.0096581.s009
(TIF)
Acknowledgments
We gratefully acknowledge the help of Dr. Alaa Kotb for providing his expertise in the field of cardiology and Agnieszka Szczotka for her help in devising the search strategies needed for conducting this review.
Author Contributions
Conceived and designed the experiments: AK GW SH. Performed the experiments: AK GW SH. Analyzed the data: AK GW. Wrote the paper: AK. Wrote the first draft of the manuscript: AK. Contributed to the writing of the manuscript: AK GW SH.
References
- 1. Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, et al. (2001) Exercise-based rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, Issue 1. [DOI: https://doi.org/10.1002/14651858.CD001800].
- 2. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, et al. (2004) Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. American Journal of Medicine 116(10): 682–92.
- 3. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, et al. (2007) Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 115(20): 2675–82.
- 4.
Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, et al. (2007) European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). European Journal of Cardiovascular Prevention and Rehabilitation (Suppl 2):S1–113.
- 5.
National Institute for Health and Clinical Excellence (2007) MI: Secondary prevention. Secondary prevention in primary and secondary care for patients following a myocardial infarction. Available at http://www.nice.org.uk/CG48 [accessed 18 2 2008]. London, UK: National Institute for Health and Clinical Excellence.
- 6.
Stone JA, Arthur HM (2005) Canadian guidelines for cardiac rehabilitation and cardiovascular disease prevention, second edition, 2004: executive summary. Canadian Journal of Cardiology;21 (Suppl D):3D–19D.
- 7. Beswick AD, Rees K, Griebsch I, Taylor FC, Burke M, et al. (2004) Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups. Health Technology Assessment 8(41): 1–166.
- 8.
Davies P, Taylor F, Beswick A, Wise F, Moxham T, et al. (2010) Promoting patient uptake and adherence in cardiac rehabilitation (Review). Cochrane Database of Systematic Reviews, Issue 7.
- 9.
Inglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, et al. (2010) Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database of Systematic Reviews Issue 8. Art. No.: CD007228. DOI: 10.1002/14651858.CD007228.pub2.
- 10.
Definition of Heart Failure. MedicineNet.com. MedicineNet.com, n.d. Web. 23 January 2013. http://www.medterms.com/script/main/art.asp?articlekey=3672
- 11. Neubeck L, Redfern J, Fernandez R, Briffa T, Baumane A, et al. (2009) Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review. European Journal of Cardiovascular Prevention & Rehabilitation 16: 281–289.
- 12.
Definition of Coronary artery disease. MedicineNet.com. MedicineNet.com, n.d. Web. 25 June 2012. www.medterms.com/script/main/art.asp?articlekey=10267
- 13. Arthur HM, Smith KM, Kodis J, McKelvie R (2002) A controlled trial of hospital versus home-based exercise in cardiac patients. Medicine and Science in Sports and Exercise. 34(10): 15441550
- 14. Bambauer KZ, Aupont O, Stone PH, Locke SE, Mullan MG, et al. (2005) "The effect of a telephone counseling intervention on self-rated health of cardiac patients.". Psychosomatic Medicine 67(4): 539–545.
- 15. Bazargani RH, Besharat MA, Ehsan HB, Nejatian M, Hosseini K (2011) The efficacy of Chronic Disease Self Management Programs and Tele-health on psychosocial adjustment by increasing self-efficacy in patients with CABG. Procedia - Social and Behavioral Sciences 30: 817–821.
- 16. Beckie T (1989) A supportive-educative telephone program: Impact on knowledge and anxiety after coronary artery bypass graft surgery. Heart and Lung: Journal of Critical Care 18(1): 46–55.
- 17. Gallagher R, McKinley S, Dracup K (2003) Effects of a telephone counseling intervention on psychosocial adjustment in women following a cardiac event. Heart and Lung: Journal of Acute and Critical Care 32(2): 79–87.
- 18. Hanssen TA, Nordrehaug JE, Eide GE, Rokne B (2007) Improving outcomes after myocardial infarction: A randomized controlled trial evaluating effects of a telephone follow-up intervention. European Journal of Cardiovascular Prevention and Rehabilitation 14 (3): 429–437.
- 19. Hanssen TA, Nordrehaug JE, Eide GE, Hanestad BR (2009) Does a telephone follow-up intervention for patients discharged with acute myocardial infarction have long-term effects on health-related quality of life? A randomised controlled trial. Journal of Clinical Nursing 18(9): 1334–1345.
- 20.
Hartford K, Wong C, Zakaria D (2002) Randomized controlled trial of a telephone intervention by nurses to provide information and support to patients and their partners after elective coronary artery bypass graft surgery: Effects of anxiety. Heart and Lung: Journal of Acute and Critical Care, 31(3), 199–206.
- 21. Holmes-Rovner M, Stommel M, Corser WD, Olomu A, Holtrop JS, et al. (2008) Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome? Journal of General Internal Medicine 23(9): 1464–70.
- 22. Ma Y, Ockene IS, Rosal MC, Merriam PA, Ockene JK, et al. (2010) Randomized trial of a pharmacist-delivered intervention for improving lipid-lowering medication adherence among patients with coronary heart disease. Cholesterol 2010: 1–11.
- 23. McLaughlin TJ, Aupont O, Bambauer K, Stone P, Mullan MG, et al. (2005) Improving psychologic adjustment to chronic illness in cardiac patients: The role of depression and anxiety. Journal of General Internal Medicine 20(12): 1084–1090.
- 24. Mittag O, China C, Hoberg E, Juers E, Kolenda K, et al. (2006) Outcomes of cardiac rehabilitation with versus without a follow-up intervention rendered by telephone (Luebeck follow-up trial): overall and gender-specific effects. International journal of rehabilitation research Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 29(4): 295–302.
- 25. Neubeck L, Redfern J, Briffa T, Ascanio R, Freedman SB, et al. (2009) Cardiovascular risk benefits of the CHOICE (Choice of Health Options In prevention of Cardiovascular Events) program are maintained for four years: Randomised controlled trial. European Heart Journal Conference: European Society of Cardiology, ESC Congress 2009 Barcelona Spain. Conference Start: 20090829 Conference End: 20090902. Conference Publication: (var.pagings) 30: 76.
- 26. Neubeck L, Freedman SB, Briffa T, Bauman A, Redfern J (2011) Four-year follow-up of the choice of health options in prevention of cardiovascular events randomized controlled trial. European Journal of Cardiovascular Prevention and Rehabilitation.18(2)278286
- 27. Redfern J, Briffa T, Ellis E, Freedman SB (2008) Patient-centered modular secondary prevention following acute coronary syndrome: A randomized controlled trial. Journal of Cardiopulmonary Rehabilitation and Prevention.28(2)107117
- 28. Redfern J, Briffa T, Ellis E, Freedman SB (2009) Choice of secondary prevention improves risk factors after acute coronary syndrome: 1-Year follow-up of the CHOICE (Choice of Health Options in prevention of Cardiovascular Events) randomised controlled trial. Heart 95 (6): 468–475.
- 29. Redfern J, Menzies M, Briffa T, Freedman SB (2010) Impact of medical consultation frequency on modifiable risk factors and medications at 12 months after acute coronary syndrome in the CHOICE randomised controlled trial. International Journal of Cardiology 145 (3): 481–486.
- 30. Reid RD, Pipe AL, Quinlan B, Oda J (2007) Interactive voice response telephony to promote smoking cessation in patients with heart disease: A pilot study. Patient Education and Counseling 66 (3): 319–326.
- 31. Smith KM, Arthur HM, McKelvie RS, Kodis J (2004) Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation. European Journal of Cardiovascular Prevention and Rehabilitation 11(4): 313–319.
- 32.
Smith KM (2007) Sustainability of exercise capacity and quality of life after home or hospital based exercise training in low-risk patients following coronary artery bypass graft surgery: a six-year follow-up of a randomized controlled trial, McMaster University (Canada): 176 p–176 p.
- 33. Smith KM, McKelvie RS, Thorpe KE, Arthur HM (2011) Six-year follow-up of a randomised controlled trial examining hospital versus home-based exercise training after coronary artery bypass graft surgery. Heart 97(14): 1169–1174.
- 34.
Stevens B (1985) The effectiveness of patient education follow-up by telephone on knowledge of post-myocardial infarction patients. (M.Nus., University of Alberta (Canada)). ProQuest Dissertations and Theses (303461144).
- 35. Tranmer JE, Parry MJE (2004) Enhancing postoperative recovery of cardiac surgery patients - A randomized clinical trial of an advanced practice nursing intervention. Western Journal of Nursing Research 26(5): 515–532.
- 36.
Vale MJ, Jelinek MV, Best JD, Dart AM, Grigg LE, et al. (2003) Coaching patients on achieving cardiovascular health (COACH): A multicenter randomized trial in patients with coronary heart disease. Archives of Internal Medicine–. 163(22)27752783
- 37.
Vale MJ, Jelinek MV, Best JD, Santamaria JD (2002) Coaching patients with coronary heart disease to achieve the target cholesterol: A method to bridge the gap between evidence-based medicine and the "real world" - randomized controlled trial. Journal of Clinical Epidemiology. 55(3)245252
- 38. van Elderen-van Kemenade T, Maes S, van den Broek Y (1994) Effects of a health education programme with telephone follow-up during cardiac rehabilitation. British Journal of Clinical Psychology 33(3): 367–378.
- 39.
Barth J, Critchley JA, Bengel J (2008) Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD006886. DOI: 10.1002/14651858.CD006886.
- 40.
Taylor RS, Dalal H, Jolly K, Moxham T, Zawada A (2010) Home-based versus centre-based cardiac rehabilitation. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD007130. DOI: 10.1002/14651858.CD007130.pub2.
- 41.
Whalley B, Rees K, Davies P, Bennett P, Ebrahim S, et al.. (2011) Psychological interventions for coronary heart disease. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD002902. DOI:10.1002/14651858.CD002902.pub3.
- 42. Versteeg H, Hoogwegt MT, Hansen TB, Pedersen SS, Zwisler AD, et al. (2013) Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease. Journal of psychosomatic research 75(6): 518–25.
- 43.
Ekici B, Ercan EA, Cehreli S, Tore HF (2014) The effect of emotional status and health-related quality of life on the severity of coronary artery disease." Kardiol Pol [Epub ahead of print].
- 44. Frasure-Smith N, Lesperance F (2008) Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry 65(1): 62–71.