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Self-management techniques show promise in treating angina
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The use of self-management strategies for angina can significantly improve the frequency and physical limitations of this chronic condition, according to findings in a meta-analysis.
Additionally, self-management interventions can decrease the need for sublingual nitrates and alleviate depression in some cases, the researchers found.
The meta-analysis included nine randomized controlled trials, published between 1994 and 2012, involving 1,282 adult patients with ischemic heart disease and class I to IV angina, as defined by the Canadian Cardiovascular Society. All patients reported stable symptoms for at least 3 months and underwent routine care or intervention involving cognitive and behavioral self-management techniques for angina, including supportive coaching, anxiety/stress management, exercise and nutrition programs, medication reviews, relaxation training and energy conservation techniques.
Evaluated outcome measures included the frequency and stability of angina symptoms and the associated use of sublingual nitrates; factors influencing health-related quality of life, including physical restrictions, perception of disease and satisfaction with treatment; and psychological well-being, as indicated by symptoms of anxiety and/or depression.
Researchers observed significant improvement in the frequency of angina symptoms (standardized mean difference [SMD], 0.3; 95% CI, 0.14-0.47), along with a decrease in the use of sublingual nitrates (SMD, –0.49; 95% CI, –0.77 to –0.2), after patients received self-management training. There were also significant improvements in physical limitation scores among those who received self-management training (SMD, 0.38; 95% CI, 0.2-0.55).
The relationship between self-management interventions and anxiety was unclear, due to significant heterogeneity across evaluable studies. However, sensitivity analysis in which the trial with the widest CI was removed eliminated the heterogeneity and indicated a significant reduction in anxiety symptoms after self-management training (SMD, –0.27; 95% CI, –0.47 to –0.06). Significant improvements to depression symptoms were also observed; however, heterogeneity across studies was significant and was not affected by the removal of any single study during sensitivity analysis.
The researchers concluded that self-management approaches may be valuable at both the patient and institutional levels, where they may represent a cost savings.
“[Self-management] interventions appear to be effective for improving the frequency of angina symptoms and related physical limitation,” they wrote. “… The ideal intervention design to yield maximal and replicable long-term benefit for patients remains unknown. Future work is needed to examine the relative effectiveness of successful intervention designs in the context of robust, multi-site trials with long-term follow-up.”
Disclosure: The researchers report no relevant financial disclosures.
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