Secondary Prevention Education Initiated in Hospital for People with Coronary Heart Disease: A Systematic Review and Meta-Analysis

AIMS: To determine the effects of secondary prevention education initiated in hospital in people admitted with coronary heart disease (CHD) on knowledge, quality of life (QOL) and readmissions.

METHODS: Seven databases were searched from inception until December 2024 for trials published in English comparing the effect of education interventions initiated in hospital with usual care on CHD knowledge, QOL, and risk of hospital readmissions. Data was pooled using a random-effects model. Digital and non-digital modes of education were compared with usual care in subgroup analyses.

RESULTS: Forty-three trials were included in the review and 32 trials of 6057 participants were included in the meta-analyses. There were variations in intervention mode of delivery, duration, and frequency of follow-up. Risk of bias was low or unclear in most studies. Compared with usual care, education initiated in hospital increased knowledge (SMD:1.64 [95%CI:0.60, 2.68]) and QOL (SMD:0.74 [95%CI:0.21, 1.26]), and decreased risk of readmissions (RR:0.73 [95%CI:0.56, 0.96]). Digital modes of education improved knowledge (SMD:0.92 [95%CI:0.37, 1.46]) and QOL (SMD:0.28 [95%CI:0.07, 0.48]) compared with usual care, but did not reduce readmissions. Non-digital modes of education reduced risk of readmissions (RR:0.72 [95%CI:0.53, 0.98]) and improved QOL (SMD:1.19 [95%CI:0.14, 2.24]) but did not increase knowledge.

CONCLUSION: In people hospitalised with CHD, initiating secondary prevention education in hospital improved CHD knowledge and QOL, and reduced risk of hospital readmissions. This study provides evidence that secondary prevention education programs should be initiated before discharge. Digital modes of education are promising and may improve early access to secondary prevention education.