Table 2

Characteristics and interventions of included systematic reviews and meta-analysis involved patients with ACS

First author, year; journalPrimary objectives
(to assess effect of interventions on….)		Studies detailsInterventionOutcomes
(primary outcomes were in bold)
‘−': No change
‘↑': Increase
‘↓': Decrease		Synthesis methods
Educational contentProviderNumber of session(s), delivery mode, time, setting
Devi, 201544; The Cochrane LibraryLifestyle changes and medicines managementNumber of studies: 11 completed trials (12 publications);
Types of studies: RCTs;
Total sample: 1392 participants		All internet-based interventions√ BEHA (-)
√ CVR (-)
√ DIET (-)
√ EXERCISE (-)
□ MED
√ PSY(-)
√ SMOKING (-)
□ SELF		Dietitians; exercise specialists; nurse practitioners; physiotherapist rehabilitation specialists, or did not describe.Number of session: weekly or monthly or unclear;
Total contact hours: unclear.
Duration: from 6 weeks to 1 year		Strategies: internet-based and mobile phone-based intervention, such as email access, private-messaging function on the website, one-to-one chat facility, a synchronised group chat, an online discussion forum, or telephone consultations; or video files;
Format: one-on-one chat sessions; ‘ask an expert’ group chat sessions;
Theoretical approach: unclear		Inpatient settings, postdischarge, other− Clinical outcomes; − Cardiovascular risk factors;
− Lifestyle changes;
− Compliance with medication;
− Healthcare utilisation and costs;
↓ Adverse intervention effects		Meta-analysis used Review Manager software
Barth, 201569; The Cochrane LibrarySmoking cessationNumber of studies:40 RCTs;
Types of studies: RCTs;
Total sample: 7928 participants		Psychosocial smoking cessation interventions□ BEHA
□ CVR
□ DIET
□ EXERCISE
□ MED
□ PSY
√ SMOKING
□ SELF		Cardiologist; general practitioner physician or study nurseNumber of session: weekly or 2–3 times per week;
Total contact hours: unclear.
Duration: from 8 weeks to 1 year		Strategies: face-to-face, telephone contact, written educational materials, videotape, booklet or unclear;
Format: one by one counselling; telephone call; group meetings or unclear;
Theoretical approach: TTM, SCT		Inpatient settings, postdischarge, other↑ Abstinence by self-report or validatedMeta- analysis used Review Manager software
Kotb, 201459; PLoS OnePatients’ outcomesNumber of studies: 26 studies;
Types of studies: RCTs;
Total sample: 4081 participants		Telephone-delivered postdischarge interventions□ BEHA
√ CVR
□ DIET
□ EXERCISE
□ MED
□ PSY
□ SMOKING
□ SELF		Dietitians; exercise specialist; health educators; nurses and pharmacistsNumber of session: 3–6 sessions/telephone calls and was greater than six calls in five studies; or unclear;
Total contact hours: 40 –180 mins or unclear;
Duration: 1.5–6 months or unclear		Strategies: telephone calls;
Format: unclear, did not describe the format;
Theoretical approach: unclear		Unclear, did not describe the setting↓ All-cause hospitalisation;
− All-cause mortality;
↓ Depression;
− Anxiety;
↑ Smoking cessation,
↓ Systolic blood pressure;
− LDL-c		Meta- analysis used Review Manager software
Ghisi, 201450; Patient Education and CounselingKnowledge, health behaviour change, medication adherence, psychosocial well-beingNumber of studies: 42 articles;
Types of studies: 30 were experimental: 23 RCTs and 7 quasi-experimental; and 11 observational and 1 used a mixed-methods design.
Total sample: 16 079 participants		Any educational interventions√ BEHA (+)
√ CVR (++)
√ DIET (+++)
√ EXERCISE (++)
√ MED (++)
√ PSY(++)
√ SMOKING (+)
□ SELF		Nurses (35.7%), a multidisciplinary team (31%), dietitians (14.3%) and a cardiologist (2.4%)Number of session: 1–24 or unclear.
Total contact hours: 5–10 min to 3 hours as well as a full day of education
Duration: 1–24 month; from daily education to every 6 months		Strategies: did not describe the strategies;
Format: group (88.1%) education was delivered by lectures (40.5%), group discussions (40.5%) and question and answer periods (7.1%). Individual education (88.1%), including individual counselling (50%), follow-up telephone contacts (31%) and home visits (7.1%);
Theoretical approach: unclear		Inpatient settings− Knowledge;
− Behaviour;
− Psychosocial indicators		Narrative synthesis
Brown, 201337; European Journal of Preventive CardiologyMortality, morbidity, HRQoL and healthcare costsNumber of studies: 24 papers reporting on 13 RCTs;
Types of studies: RCTs;
Total sample: 68 556 participants		Patient education□ BEHA
√ CVR
□ DIET
□ EXERCISE
□ MED
□ PSY
□ SMOKING
□ SELF		Nurses or other healthcare professionals.Number of session and duration: from a total of 2 visits to a 4 -week residential stay reinforced with 11 months of nurse led follow-up
Total contact hours: unclear		Strategies: face-to-face education sessions, telephone contact and interactive use of the internet;
Format: group-based sessions, individualised education and four used a mixture of both sessions;
Theoretical approach: unclear		Inpatient settings, other− Mortality,
− Non-fatal MI,
− Revascularisations,
− Hospitalisations,
− HRQoL,
− Withdrawals/dropouts;
− Healthcare utilisation and costs		Meta- analysis used Review Manager software
Dickens, 201345; Psychosomatic MedicineDepression
and depressive symptoms		Number of studies: 62 independent studies
Types of studies: RCTs;
Total sample: 17 397		Psychological interventions√ BEHA (-)
□ CVR
□ DIET
□ EXERCISE
□ MED
√ PSY (-)
□ SMOKING
√ SELF (-)		A single health professional or by a unidisciplinary teamNumber of session: 14.4 (range, 1–156);
Total contact hours: varying from 10 to 240 min
Duration: unclear		Strategies: face-to-face sessions, telephone contact or unclear;
Format: group or unclear;
Theoretical approach: unclear		Unclear, did not describe↓ Depression;
− Adverse cardiac outcomes;
− Ongoing cardiac symptoms		Univariate analyses using comprehensive meta-analysis, multivariate meta-regression using SPSS V.15.0
Aldcroft, 201120; Journal of Cardiopulmonary Rehabilitation & PreventionHealth behaviour changeNumber of studies: seven trials
Types of studies: six randomised controlled trials and a quasi-experimental trial
Total sample: 536 participants		All psychoeducational or behavioural intervention□ BEHA
√ CVR (-)
□ DIET
□ EXERCISE
□ MED
√ PSY (-)
□ SMOKING
□ SELF		Appropriately trained healthcare workersNumber of session: unclear;
Total contact hours: unclear;
Duration: 2–12 months		Strategies: did not describe the strategies;
Format: group setting, combination of group and one-on-one education and one-on-one format only;
Theoretical approach: TTM, interactionist role theory, Bandura’s self-efficacy theory, Gordon’s relapse prevention model and a cognitive behavioural approach		Unclear, did not describe↓ Smoking rates; medication use;
− Supplemental oxygen use;
↑ Physical activity;
↑ Nutritional habits		Meta-analysis and narrative presentation
Brown, 201170; The Cochrane LibraryMortality, morbidity, HRQoL and healthcare costsNumber of studies: 24 papers reporting on 13 studies.
Types of studies: RCTs;
Total sample: 68 556 participants		Patient education√ BEHA (-)
√ CVR (-)
□ DIET
√ EXERCISE (-)
√ MED
□ PSY
□ SMOKING
□ SELF		Nurse or did not describeNumber of session and duration: two
visits to 4 weeks residential
11 months of nurse led follow-up
Total contact hours: unclear		Strategies: face-to-face sessions, telephone contact and interactive use of the internet;
Format: four studies involved group sessions, five involved individualised education and three used both session types, with one study comparing the two approaches;
Theoretical approach: did not describe		Postdischarge, other− Total mortality;
− Cardiovascular
− mortality;
− Non-cardiovascular mortality;
− Total cardiovascular (CV) events;
− Fatal and/or non-fatal MI;
− Other fatal and/or non-fatal CV events		Meta-analysis used Review Manager software
Goulding, 201051; Journal of Advanced NursingChange maladaptive illnessNumber of studies: 13 studies;
Types of studies: RCTs;
Total sample: unclear		Interventions to change maladaptive illness beliefs√ BEHA (-)
□ CVR
DIET
□ EXERCISE
□ MED
√ PSY (-)
□ SMOKING
□ SELF		Cardiologist, nurse, psychologist or did not describe.Number of session: unclear;
Total contact hours: unclear;
Duration: 4 days to 2 weeks or unclear		Strategies: face-to-face sessions, telephone contact and written self-administered;
Format: unclear;
Theoretical approach: Common Sense Model, Leventhal’s framework		Inpatient settings, postdischarge, other− Beliefs (or other illness cognition);
− QoL;
− Behaviour;
− Anxiety or depression;
− Psychological well-being;
− Modifiable risk factors; protective factors		A descriptive data synthesis
Huttunen-Lenz, 201056; British Journal of Health PsychologySmoking cessationNumber of studies: a total of 14 studies were included
Types of studies: RCTs;
Total sample: 1792 participants		Psychoeducational cardiac rehabilitation intervention□ BEHA
□ CVR
□ DIET
□ EXERCISE
□ MED
□ PSY
√ SMOKING (-)
□ SELF		Cardiologist, nurse psychologist or did not describeNumber of session: 4–20 or unclear.
Total contact hours: 10–720 mins or unclear
Duration: 4–29 weeks or unclear		Strategies: face-to-face counselling, self-help materials; home visit, booklet, video and telephone contact
Format: individual or unclear
Theoretical approach: social learning theory; ASE model; TTM; behavioural multicomponent approach		Inpatient settings, postdischarge, other↑ Prevalent smoking cessation,
↑ Continuous smoking cessation,
− Mortality		Subgroup meta-analysis was used software
Auer, 200834; CirculationMultiple cardiovascular risk factors and all-cause mortalityNumber of studies: 27 articles reporting 26 studies
Types of studies: 16 clinical controlled trials and 10 before-after studies
Total sample: 2467 patients in CCTs and 38, 581 patients in before-after studies		In-hospital multidimensional interventions of secondary prevention□ BEHA
□ CVR
√ DIET (-)
√ EXERCISE (-)
√ MED
√ PSY (-)
√ SMOKING (-)
□ SELF		Cardiac nurses; physician, or did not describeNumber of session: 1–5 or unclear;
Total contact hours: 30–240 mins or unclear;
Duration: 4 weeks–12 months		Strategies: Written material; audiotapes; presentations; face-to-face;
Format: group or unclear;
Theoretical approach: unclear		Inpatient settings↓ All-cause mortality;
↓ Readmission rates;
− Reinfarction rates		Stata V.9.1
Barth, 200836;
The Cochrane Library		Smoking cessationNumber of studies: 40 trials;
Types of studies: RCTs;
Total sample: 7682 patients		Psychosocial intervention√ BEHA (+++)
√ CVR (++)
□ DIET
□ EXERCISE
□ MED
√ PSY (+)
√ SMOKING (+++)
√ SELF(+++)		Cardiologist, nurse, physician or study nurseNumber of session: 1–5 or unclear;
Total contact hours: 15 mins–9 hours
Duration: within 4 weeks or did not report on the duration		Strategies: face-to-face; information booklets, audiotapes or videotapes
Format: group sessions or individual counselling;
Theoretical approach: TTM		Inpatient settings↑ Abstinence by self-report or validatedMeta-analysis used Review Manager software
Fernandez, 200748; International Journal of Evidence-Based HealthcareRisk factor modificationNumber of studies: 17 trials;
Types of studies: randomised, quasi-RCTs and clustered trials;
Total sample: 4725 participants		Brief structured intervention√ BEHA (-)
□√ CVR (-)
□ DIET
□ EXERCISE
□ MED
□ PSY
□ SMOKING
√ SELF (-)		Case manager; dieticians; health educator; nurses; psychologist; and research assistantsNumber of session: supportive counselling ranged from 1 to 7 calls for the duration of the study;
Total contact hours: varied from 10 to 30 mins;
Duration: unclear		Strategies: written, visual, audio, telephone contact;
Format: did not describe;
Theoretical approach: theoretical behaviour change principles		Unclear, did not describe↓ Smoking;
− Cholesterol level;
− Physical activity;
↑ Dietary habits;
↓ Blood sugar levels;
− BP levels;
↓ BMI;
− Incidence of admission		Cochrane statistical package Review Manager
Barth, 200635; Annals of Behavioural MedicineSmoking cessationNumber of studies: 19 trials;
Types of studies: RCTs;
Total sample: 2548 patients		Psychosocial interventions√ BEHA (+++)
√ CVR (++)
□ DIET
□ EXERCISE
□ MED
□ PSY
□ SMOKING
√ SELF (+++)		Unclear, did not describeNumber of session: unclear;
Total contact hours: unclear;
Duration: unclear		Strategies: face-to-face, telephone contact or unclear;
Format: unclear;
Theoretical approach: unclear		Unclear, did not describe↑ Abstinence;
↓ Smoking status		Data analyses were carried out in Review Manager V.4.2
Clark, 200541; Annals of Internal MedicineMortality, MINumber of studies: 63 randomised trials;
Types of studies: RCTs;
Total sample: 21 295 patients		Secondary prevention programmes□ BEHA
□ CVR
√ DIET (-)
√ EXERCISE (-)
□ MED
√ PSY (-)
□ SMOKING
□ SELF		Nurse, multidisciplinary team or did not describeNumber of session: 1–12 or unclear
Total contact hours: did not describe
Duration: 0.75–48 months		Strategies: face-to-face, telephone contact and home visit;
Format: group and individual or unclear;
Theoretical approach: unclear		Inpatient settings, postdischarge, other↓ Mortality,
↓ MI,
− Hospitalisation rates		Performed analyses by using Review Manager V.4.2 and Qualitative Data Synthesis

  • Smoking, smoking cessation; CVR, cardiovascular risk factors; PSY, psychosocial issues (depression, anxiety); DIET, diet; EXERCISE, exercise; MED, medication; BEHA, behavioural charge (including lifestyle modification); SELF, self-management (including problems solving); DR, diabetes risks; CHD, coronary heart disease; CAD, coronary artery disease; CHW, community health worker; HbA1c, glycated haemoglobin; BP, blood pressure; LDL, low-density lipoprotein cholesterol; SMS, short message service; BCTs, behavioural change techniques; LEA, lower extremity amputation; PRIDE, Problem Identification, Researching one’s routine, Identifying a management goal, Developing a plan to reach it, Expressing one’s reactions and Establishing rewards for making progress; ASE, attitude social influence-efficacy; CVRF, cardiovascular risk factors; PA, physical activity; EDU, patient education; GP, general practice; RCTs, randomised controlled trials; CCTS, controlled clinical trials; HRQoL, health-related quality of life; QoL, quality of life; MI, myocardial infarction; CAD, coronary artery disease; CABG, coronary artery bypass graft surgery; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; HDL-c, high-density lipoprotein cholesterol; TTM, transtheoretical model; SCT, social cognitive theory; HBM, health belief model; SAT, social action theory.

  • In the educational content: ‘+’: minor focus; ‘++’:moderate focus; ‘+++’ major focus; ‘- ’=unclear what the intensity of the education was for any topic.

  • In the outcomes: arrow up (‘↑’) for improvement, arrow down (‘↓’) for reduction; a dash (‘−’) for no change or inconclusive evidence. Primary outcomes were in bold.