Key result
Behaviour change interventions for coronary heart disease patients significantly reduced the risk of mortality (RR 0.82) but did not significantly reduce the risk of CHD events.
Why the study?
Do behaviour change interventions reduce mortality and CHD events in patients with coronary heart disease?
Meta-Analysis (n=16,766)
Do behaviour change interventions reduce mortality and CHD events in patients with coronary heart disease?
Relative Risk: 0.82 (95% CI 0.69–0.97)
Behaviour change interventions in CHD patients reduce mortality and smoking rates, although specific active behaviour change techniques predicting mortality could not be isolated.
Supports adoption of behaviour change interventions in CHD care; extends evidence for mortality benefit in secondary prevention.
BACKGROUND: The main behaviour change intervention available for coronary heart disease (CHD) patients is cardiac rehabilitation. There is little recognition of what the active ingredients of behavioural interventions for CHD might be. Using a behaviour change technique (BCT) framework to code existing interventions may help to identify this. The objectives of this systematic review are to determine the effectiveness of CHD behaviour change interventions and how this may be explained by BCT content and structure. METHODS AND FINDINGS: A systematic search of Medline, EMBASE and PsycInfo electronic databases was conducted over a twelve year period (2003-2015) to identify studies which reported on behaviour change interventions for CHD patients. The content of the behaviour change interventions was coded using the Coventry Aberdeen and London-Refined (CALO-RE) taxonomy. Meta-regression analyses examined the BCT content as a predictor of mortality. Twenty two papers met the criteria for this review, reporting data on 16,766 participants. The most commonly included BCTs were providing information, and goal setting. There was a small but significant effect of the interventions on smoking (risk ratio (RR) = 0.89, 95% CI 0.81-0.97). The interventions did not reduce the risk of CHD events (RR = 0.86, 95% CI 0.68, 1.09), but significantly reduced the risk of mortality (RR = 0.82, 95% CI 0.69, 0.97). Sensitivity analyses did not find that any of the BCT variables predicted mortality and the number of BCTs included in an intervention was not associated with mortality (β = -0.02, 95% CI -0.06-0.03). CONCLUSIONS: Behaviour change interventions for CHD patients appear to have a positive impact on a number of outcomes. Using an existing BCT taxonomy to code the interventions helped us to understand which were the most commonly used techniques, providing information and goal setting, but not the active components of these complex interventions.
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Goodwin et al. (2016) conducted a meta-analysis in Coronary heart disease (n=16,766). Behaviour change interventions vs. Usual care was evaluated on Mortality (RR 0.82, 95% CI 0.69-0.97). Behaviour change interventions for coronary heart disease patients significantly reduced the risk of mortality (RR 0.82) but did not significantly reduce the risk of CHD events.
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