title: Effect of patient education in the management of coronary heart disease: a systematic review and meta-analysis of randomized controlled trials.
abstract: 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).
  
  
  METHODS
  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.
authors.affiliation: British Columbia Women's Hospital, Vancouver, Canada. jprb_brum@yahoo.com
authors.forename: James P R
authors.initials: JP
authors.lastname: Brown
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Clark
authors.forename: Hasnain
authors.initials: H
authors.lastname: Dalal
authors.forename: Karen
authors.initials: K
authors.lastname: Welch
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
mesh_terms: D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D017046:Cost Savings; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D016017:Odds Ratio; D010353:Patient Education as Topic / Q000191:economics; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention / Q000191:economics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome