Therapeutic education in cardiovascular diseases: state of the art and perspectives.
OBJECTIVE
To assess the impact of therapeutic education programmes for Coronary Artery Disease (CAD) and Chronic Heart Failure (CHF), as well as patients' expectations and education needs, tips to improve adherence to lifestyle modifications, and education materials.


METHODS
We conducted a systematic review of the literature from 1966 to 2010 on Medline and the Cochrane Library databases using following key words: "counselling", "self-care", "self-management", "patient education" and "chronic heart failure", "CAD", "coronary heart disease", "myocardial infarction", "acute coronary syndrome". Clinical trials and randomized clinical trials, as well as literature reviews and practical guidelines, published in English and French were analysed.


RESULTS
Therapeutic patient education (TPE) is part of the non-pharmacological management of cardiovascular diseases, allowing patients to move from an acute event to the effective self-management of a chronic disease. Large studies clearly showed the efficacy of TPE programmes in changing cardiac patients' lifestyle. Favourable effects have been proved concerning morbidity and cost-effectiveness even though there is less evidence for mortality reduction. Numerous types of intervention have been studied, but there are no recommendations about standardized rules and methods to deliver information and education, or to evaluate the results of TPE. The main limit of TPE is the lack of results for adherence to long-term lifestyle modifications.


CONCLUSIONS
The efficacy of TE in cardiovascular diseases could be improved by optimal collaboration between acute cardiac units and cardiac rehabilitation units. The use of standardized rules and methods to deliver information and education and to assess their effects could reinforce this collaboration. Networks for medical and paramedical TPE follow-up in tertiary prevention could be organized to improve long-term results.
Service de médecine physique et réadaptation, CHU de Toulouse, université Paul-Sabatier, 1, avenue J.-Poulhès, 31059 Toulouse, France.
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M
Labrunée
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Pathak
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Loscos
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Coudeyre
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JM
Casillas
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Gremeaux
D000359:Aftercare; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003299:Cooperative Behavior; D004032:Diet; D037001:Directive Counseling; D015438:Health Behavior; D006293:Health Promotion; D006757:Hospital Units; D006801:Humans; D033183:Interdisciplinary Communication; D008019:Life Style; D009043:Motor Activity; D010349:Patient Compliance; D010353:Patient Education as Topic; D010551:Personality; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention / Q000458:organization & administration; D012648:Self Care; D016540:Smoking Cessation; D055512:Tertiary Prevention / Q000458:organization & administration