Impact of self-management interventions on stable angina symptoms and health-related quality of life: a meta-analysis.
BACKGROUND
Chronic stable angina (CSA) has a major negative impact on health-related quality of life (HRQL) including poor general health status, psychological distress, and inability to self-manage.


METHODS
We used meta-analysis to assess the effectiveness of self-management interventions for improving stable angina symptoms, HRQL and psychological well-being. Nine trials, involving 1,282 participants in total, were included. We used standard inverse-variance random-effects meta-analysis to combine the trials. Heterogeneity between trials was evaluated using chi-square tests for the tau-squared statistic and quantified using the I2 statistic.


RESULTS
There was significant improvement in the frequency of angina symptoms (Seattle Angina Questionnaire [SAQ], symptom diary) across trials, standardized mean difference (SMD): 0.30 (95% Confidence interval [CI] 0.14, 0.47), as well as reduction in the use of sublingual (SL) nitrates, SMD: -0.49 (95% CI -0.77, -0.20). Significant improvements for physical limitation (SAQ), SMD: 0.38 (95% CI 0.20, 0.55) and depression scores (Hospital Anxiety and Depression Scale), SMD: -1.38 (95% CI -2.46, -0.30) were also found. The impact of SM on anxiety was uncertain due to statistical heterogeneity across trials for this outcome, I2 = 98%. SM did not improve other HRQL dimensions including angina stability, disease perception, and treatment satisfaction.


CONCLUSIONS
SM interventions significantly improve angina frequency and physical limitation; they also decrease the use of SL nitrates and improve depression in some cases. Further work is needed to make definitive conclusions about the impact of SM on cardiac-specific anxiety.
Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSC 2J20A, Hamilton, ON L8S 4K1, Canada. mmcgill@mcmaster.ca.
Michael
M
McGillion
Sheila
S
O'Keefe-McCarthy
Sandra L
SL
Carroll
J Charles
JC
Victor
Tammy
T
Cosman
Allison
A
Cook
John G
JG
Hanlon
E Marc
EM
Jolicoeur
Noorin
N
Jamal
Robert
R
McKelvie
Heather M
HM
Arthur
D060050:Angina, Stable / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D016009:Chi-Square Distribution; D003863:Depression / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008603:Mental Health; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome