title: Effectiveness of nonpharmacological secondary prevention of coronary heart disease.
abstract: OBJECTIVE
  To summarize the current evidence with regard to the effectiveness of nonpharmacological secondary prevention strategies of coronary heart disease (CHD) and to investigate the comparative effectiveness of interventions of different categories, specific intervention components and the effectiveness in patient subgroups.
  
  
  METHODS
  A structured search of databases and manual search were conducted. Clinical trials and meta-analyses published between January 2003 and September 2008 were included if they targeted adults with CHD, had a follow-up of at least 12 months, and reported mortality, cardiac events or quality of life. Two researchers assessed eligibility and methodological quality, in which appropriate, pooled effect estimates were calculated and tested in sensitivity analyses.
  
  
  RESULTS
  Of 4798 publications 43 met the inclusion criteria. Overall study quality was satisfactory, but only about half of the studies reported mortality. Follow-up duration varied between 12 and 120 months. Despite substantial heterogeneity, there was strong evidence of intervention effectiveness overall. The evidence for exercise and multimodal interventions was more conclusive for reducing mortality, whereas psychosocial interventions seemed to be more effective in improving the quality of life. Rigorous studies investigating dietary and smoking cessation interventions, specific intervention components and important patient subgroups, were scarce.
  
  
  CONCLUSIONS
  Nonpharmacological secondary prevention is safe and effective, with exercise and multimodal interventions reducing mortality most substantially. There is a lack of studies concerning dietary and smoking cessation interventions. In addition, intervention effectiveness in patient subgroups and of intervention components could not be evaluated conclusively. Future research should investigate these issues in rigorous studies with appropriate follow-up duration to improve the current poor risk factor control of CHD patients.
authors.affiliation: Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany. falk.mueller-riemenschneider@charite.de
authors.forename: Falk
authors.initials: F
authors.lastname: Müller-Riemenschneider
authors.forename: Charlotte
authors.initials: C
authors.lastname: Meinhard
authors.forename: Kathrin
authors.initials: K
authors.lastname: Damm
authors.forename: Christoph
authors.initials: C
authors.lastname: Vauth
authors.forename: Angelina
authors.initials: A
authors.lastname: Bockelbrink
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Greiner
authors.forename: Stefan N
authors.initials: SN
authors.lastname: Willich
mesh_terms: D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control*; D004032:Diet; D015444:Exercise; D006801:Humans; D011613:Psychotherapy; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods; D016540:Smoking Cessation; D016896:Treatment Outcome