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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Cardiovascular Disorders 1/2014

Impact of self-management interventions on stable angina symptoms and health-related quality of life: a meta-analysis

BMC Cardiovascular Disorders > Ausgabe 1/2014
Michael McGillion, Sheila O’Keefe-McCarthy, Sandra L Carroll, J Charles Victor, Tammy Cosman, Allison Cook, John G Hanlon, E Marc Jolicoeur, Noorin Jamal, Robert McKelvie, Heather M Arthur
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2261-14-14) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MM, SC, JCV, SOM, and HMA designed this systematic review and oversaw all aspects of the methodology. MM, SOM, SC and HMA drafted first version of the manuscript. MM, JVC, SC, AC, TC, and HMA reviewed all abstracts and came to consensus on included studies. MM, SOM, SC, and NJ participated in data extraction and conducted the risk of bias assessment of included trials. JCV, JH, and EMJ piloted tested and revised the meta-analytic strategy. JCV conducted the final data analyses. RM, HMA, EMJ, and SC revised the discussion section substantively. All authors reviewed the manuscript and contributed to revising and approving the content of the final version for submission for publication.



Chronic stable angina (CSA) has a major negative impact on health-related quality of life (HRQL) including poor general health status, psychological distress, and inability to self-manage.


We used meta-analysis to assess the effectiveness of self-management interventions for improving stable angina symptoms, HRQL and psychological well-being. Nine trials, involving 1,282 participants in total, were included. We used standard inverse-variance random-effects meta-analysis to combine the trials. Heterogeneity between trials was evaluated using chi-square tests for the tau-squared statistic and quantified using the I2 statistic.


There was significant improvement in the frequency of angina symptoms (Seattle Angina Questionnaire [SAQ], symptom diary) across trials, standardized mean difference (SMD): 0.30 (95% Confidence interval [CI] 0.14, 0.47), as well as reduction in the use of sublingual (SL) nitrates, SMD: -0.49 (95% CI -0.77, -0.20). Significant improvements for physical limitation (SAQ), SMD: 0.38 (95% CI 0.20, 0.55) and depression scores (Hospital Anxiety and Depression Scale), SMD: -1.38 (95% CI -2.46, -0.30) were also found. The impact of SM on anxiety was uncertain due to statistical heterogeneity across trials for this outcome, I2 = 98%. SM did not improve other HRQL dimensions including angina stability, disease perception, and treatment satisfaction.


SM interventions significantly improve angina frequency and physical limitation; they also decrease the use of SL nitrates and improve depression in some cases. Further work is needed to make definitive conclusions about the impact of SM on cardiac-specific anxiety.
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