Effect of Patient Education in the Management of Coronary Heart Disease: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Background: To assess the effects of patient education on mortality,
morbidity, health-related quality of life (HRQoL), and healthcare costs
in people with coronary heart disease (CHD).Design: Systematic review
and meta-analysis.Methods: Data sources were Cochrane Library, Medline,
Embase, PsycINFO, CINAHL, and ongoing trial registries until August
2010. We also checked study references. The study selection was based on
design (randomized controlled trials with follow up of at least 6
months, published from 1990 onwards), population (adults with CHD),
intervention (patient education stated to be the primary intervention),
and comparators (usual care or no educational intervention).Results:
Thirteen studies (68,556 people with CHD) were included. Educational
interventions ranged from two visits to a 4-week residential stay with
11 months of reinforcement sessions. Compared to no educational
intervention, there was weak evidence that education reduced all-cause
mortality (pooled relative risk (RR) 0.79, 95% CI 0.55 to 1.13) and
cardiac morbidity outcomes: myocardial infarction (pooled RR 0.63, 95%
CI 0.26 to 1.48), revascularization (pooled RR 0.58, 95% CI 0.19 to
1.71), and hospitalization (pooled RR 0.83, 95% CI 0.65 to 1.07) at
median 18-months follow up. There was evidence to suggest that education
can improve HRQoL and decrease healthcare costs by reductions in
downstream healthcare utilization.Conclusions: Our review had
insufficient power to exclude clinically important effects of education
on mortality and morbidity. Nevertheless it supports the practice of CHD
secondary prevention and rehabilitation programmes including education
as an intervention. Further research is needed to determine the most
effective and cost-effective format, duration, timing, and methods of
education delivery.