Global mapping of interventions to improve the quality of life of patients with cardiovascular diseases during 1990–2018

Cardiovascular diseases (CVDs) have been the global health problem with rising prevalence, incidence, and death rates. In 2017, 31.8% (17.79 million cases) of global deaths were attributed to CVDs, plus nearly 336 million disability-adjusted life-years (DALY) [1]. Ischemic heart disease (IHD) and stroke account for the highest standardized death rate among CVD causes [2]. Episodes of CVDs have complex, long term impacts on the life of patients, which is far beyond survivorship, since their consequences cause impairments in physical and cognitive functioning, which, in turn, limit the daily activities and social interactions of the survivors [3‐7].

Achieving good quality of life (QOL), therefore, is crucial to patients suffering from heart and stroke diseases [3, 8]. According to the definition of World Health Organization on QOL, QOL is “affected in a complex way by the person’s physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment” [9]. QOL can be considered as one of the most important outcomes in healthcare, particularly among patients with CVDs [10]. Deterioration of QOL among CVD patients is positively correlated with higher rates of hospital readmission and fatality [11, 12]. Hence, assessing the QOL of CVD patients is critical when evaluating the effectiveness of CVD treatments and determining which aspects should be improved.

There is a remarkable growth in the body of literature regarding manners to improve the QOL of people with heart and stroke diseases. These implications range from healthier lifestyle encouragement [13] to the incorporation of mental health treatments into routine CVDs management [6]. Moreover, some initiatives have been implemented comprising: adoption of collaborative care models [14]; support and counseling of CVD specialists in the primary care setting to people at-risk of CVDs [15]; or adoption of surgical procedures, for instance, coronary artery bypass graft surgery (CABG) instead of percutaneous coronary intervention (PCI) [16].

Several systematic reviews worked on interventions that could improve the QOL of people with heart and stroke diseases. For example, life-style interventions at the workplace could decrease the risk of CVD [17], or community-based nursing interventions increase the outcome of treatment for people with CVD [18]. Besides, Widmer et al. confirmed the effectiveness of digital health interventions for the prevention of cardiovascular disease [19]. Despite the abundance of documents on the QOL and interventions targeting people with heart and stroke diseases, there is a lack of publications offering a ‘big picture’ of the interaction between interventions and QOL among CVD patients. This limits the ability of healthcare providers and policymakers to identify pathways to efficiently allocate scarce resources in CVD treatment.

The bibliometric approach has been proposed to be a potential solution given the capacity to provide a comprehensive and holistic investigation of the literature. By combining bibliometric approach and content analysis, we aimed at providing an interdisciplinary insights into research areas as well as characterizing the most common topics regarding interventions to improve QOL of CVD patients. Our findings can inform priority setting and policy development towards sustainable efforts of enhancing the lives of people with these conditions.

In this study, a total of 6457 papers was analyzed to identify the global trend and the development of research landscapes in the intervention to improve QOL of CVD patients from 1990 to 2018. The number of papers increased gradually since 2002 and reached a peak in the year of 2018. By applying text mining technique based on LDA, the interdisciplinary research topics and research areas were examined in detail. The most common topics were conventional treatment (surgery and medication), and psychological, behavioral interventions.

Our study proposed a novel approach for analyzing literature that overcomes the limitations of current systematic review/meta-analysis. Indeed, the traditional systematic review and meta-analysis cannot efficiently illustrate the research development trend as this method consumes time and human resources [31]. Meanwhile, scientometrics, when standing on its own, shows the productivity, collaborations among authors, organizations, or countries and co-occurrence of author keywords, however, the approach is unable to identify the research topics underlying the current literature [32]. By combining bibliometrics and text analysis, the study was able to explore the hidden patterns of information from the literature.

This study provides an overview of interdisciplinary research landscapes in the interventions to improve QOL of CVD patients. The majority of interventions for CVDs were conventional therapies, such as surgery and medication, or psychological and behavioral interventions. Historically, the use of medications has been a primary method of CVD treatment [33], given the lower costs of drug treatment compared to hospitalization and effectiveness in relieving symptoms, which mainly aim to slow down the disease progression and improve patients’ QoL [34]. The number of patients with end-stage heart diseases as well as the introduction of the heart-lung machine and cardiopulmonary bypass leads to the increase of surgical treatment and the number of papers mentioning this therapy, which was also confirmed by other studies [35]. Besides, several associated factors to CVDs, such as obesity, smoking, and sedentary lifestyle, have been proved in previous studies [36, 37], leading to a rise in the published works regarding interventions focusing in lifestyle changes to prevent the onset of CVD episode and elevate the patients’ QOL. Notably, traditional and alternative medicine gained the concern of scientists in the last 5 years (2014–2018). This result was in the same line with previous studies [38, 39]. It might be explained that patients believed in these approaches to reduce side-effects of conventional therapy [39], yet, there has been a lack of data for the pattern use of alternative therapy for CVDs [38]. In addition, the development of technology has enabled the research of gene therapy or robot-assistant in CVD treatment [40]. However, gene therapy has shown modest success in clinical translation [41]. Meanwhile, robot-assistant has been tried and is being investigated for rehabilitation among patients after stroke [42, 43].

Findings of this study have provided several important implications for setting priority in research, designing interventions, and improving quality of care for CVD patients. Firstly, we call for interdisciplinary approaches, specifically, the integration of research areas, such as health services in providing medical care, and psycho-socio-behavioral interventions at the individual, family, health facility, and community levels. Besides, more research should be focused on the economic aspects of interventions for CVD. Finally, there has been a lack of research on interventions to reduce mental problems (e.g., depression or stress) among people with CVD; hence, future research should focus on this phenomenon since mental issues were significant risk factors for CVD [44, 45].

Our study has several limitations. First, the choice of using WOS as the only database might limit the coverage of all possible publications in interventions to improve QoL of patients with CVD compared with Google Scholar [46], or Scopus [47]. However, a previous study recommended using WoS in the case of only one available database [48]. Second, only peer-reviewed publications in the English language were included, which might have resulted in a bias against non-English publications. Furthermore, only titles and abstracts were used for content analysis, which might not provide a deep insight intro research themes of the dataset. Hence, our findings should be interpreted with caution.

In conclusion, the number of scientific published works on the interventions to improve QOL among people with CVD has gradually increased from 1990 to 2018. The research areas in the field of the study emphasized the importance of interdisciplinary and inter-sectoral approaches in both evaluation and intervention. Conventional therapy (surgery and medication), and psychological and behavioral interventions were the common approach. Future research should focus on economic evaluation of intervention as well as interventions to reduce mental issues among people with CVD.