Article

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). DESIGN: 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.

Langue : ANGLAIS