One good quality(3) and two moderate quality(1, 2) studies examined multicomponent behaviour change interventions for reducing coronary risk factors in patients awaiting coronary artery bypass graft surgery.
All three interventions were nurse-led(1-3) and aimed to address coronary heart disease risk factors and encourage and facilitate behaviour change. Two studies consisted of monthly sessions with a nurse(2, 3), whereas one had an initial session and then monthly telephone follow-up(1). Further interventions, advice, and treatment such as medication and counselling were tailored for individual participants based on the behavioural risk factors identified from the nurse led sessions.(1-3) One study also aimed to dispel common cardiac misconceptions, and also included a relaxation programme.(1)
Interventions were compared to usual care(3), or nurse education and counselling not specific to cardiac misconceptions(1). One study does not specify what the control group received.(2)
There is good or moderate quality evidence to suggest that multicomponent behaviour change interventions for reducing coronary risk factors in patients awaiting CABG are likely to be effective for the following outcomes:
Depression:
Might be effective (two moderate quality studies(1, 2) showing improvements in the Intervention group compared to control. One strong quality study(3) showing no effect for the intervention compared to control).
Cost-effectiveness:
Might be cost effective (one strong(3) and one moderate(1) quality study concluding that the intervention might be considered cost effective).
The evidence for multicomponent behaviour change interventions for reducing coronary risk factors in patients awaiting CABG is inconsistent for the following outcomes:
BMI (coronary heart disease risk factor):
Inconsistent (one strong(3) and one moderate quality study(2); inconsistent effects across studies).
Blood pressure (coronary heart disease risk factor):
Inconsistent (one strong(3) and one moderate quality study(2); inconsistent effects across studies).
Health related quality of life:
Inconsistent (one strong(3) and one moderate quality study(2); inconsistent effects across studies).
There is good or moderate quality evidence to suggest that multicomponent behaviour change interventions for reducing coronary risk factors in patients awaiting CABG are likely to be ineffective for the following outcomes:
Anxiety:
Might not be effective (One strong(3) and one moderate quality(1) study showing no effect for the intervention compared to control. One moderate quality study(2) showing an improvement in the intervention group compared to control).
Cholesterol (coronary heart disease risk factor):
Might not be effective (One strong quality study(3) and one moderate quality study(2) both showing no improvement in total cholesterol levels for intervention compared to control. One moderate quality study(2) showed an improvement in mean plasma cholesterol concentration in the intervention group compared to control).
The evidence for multicomponent behaviour change interventions for reducing coronary risk factors in patients awaiting CABG is lacking for the following outcomes:
Physical functioning:
Might be effective (One moderate quality study showing a significant improvement for the intervention compared to control).(1)
Cardiac misconceptions:
Might be effective (One moderate quality study showing a significant effect for the intervention compared to control).(1)
Adverse events:
One moderate quality study reported no serious adverse events from the intervention.(1)
Smoking cessation (coronary heart disease risk factor):
Might be effective (One moderate quality study showing a significant effect for the intervention compared to control).(2)
Physical activity (coronary heart disease risk factor):
Might be effective (One moderate quality study showing a significant effect for the intervention compared to control).(2)
Patient satisfaction:
One moderate quality study reported that overall patients were satisfied with the intervention.(2)
Generalisability:
All three studies took place in the UK and so may be generalisable to Wales.(1-3)
Applicability:
The evidence for the outcomes listed above was derived from patients waiting for CABG surgery, and therefore may not be applicable to patients waiting for other elective surgeries.
If proceeding with this intervention:
It is suggested that further robust research and thorough evaluation of impact is needed.