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Canadian Journal of Cardiology

Self-Management Interventions for Women With Cardiac Pain: A Systematic Review and Meta-analysis

Published:December 18, 2017DOI:https://doi.org/10.1016/j.cjca.2017.12.011

      Abstract

      Background

      Cardiac pain is considered the primary indicator of coronary artery disease (CAD). Existing reviews lack appropriate numbers of women or sex-based subgroup analyses, or both; thus, the benefits of self-management (women with cardiac pain actively participating in their own care and treatment) remain uncertain.

      Methods

      Using methods described by the Evidence for Policy and Practice Information and Co-ordinating Centre at the Institute of Education, 7 databases were systematically searched to examine and synthesize the evidence on self-management interventions for women with cardiac pain and cardiac pain equivalents, such as fatigue, dyspnea, and exhaustion.

      Results

      Our search yielded 22,402 article titles and abstracts. Of these, 57 randomized controlled trials were included in a final narrative synthesis, comprising data from 13,047 participants, including 5299 (41%) women. Self-management interventions targeting cardiac pain in women compared with a control population reduced (1) cardiac pain frequency and cardiac pain proportion (obstructive and nonobstructive CAD), (2) fatigue at 12 months, and (3) dyspnea at 2 months. There was no evidence of group differences in postprocedural (percutaneous coronary intervention or cardiac surgery) pain. Results indicated that self-management interventions for cardiac pain were more effective if they included a greater proportion of women (standardized mean difference [SMD], −0.01; standard error, 0.003; P = 0.02), goal setting (SMD, −0.26; 95% confidence interval [CI], −0.49 to −0.03), and collaboration/support from health care providers (SMD, −0.57; 95% CI, −1.00 to −0.14).

      Conclusions

      The results of this review suggest that self-management interventions reduce cardiac pain and cardiac pain equivalents.

      Résumé

      Introduction

      La douleur d’origine cardiaque est considérée comme le principal indicateur de la coronaropathie. Les revues existantes disposent d’un nombre insuffisant de femmes ou d’analyses en sous-groupes fondées sur le sexe, ou les deux. Par conséquent, les avantages de la prise en charge autonome (les femmes ayant des douleurs d’origine cardiaque qui participent activement à leurs propres soins et au traitement) demeurent incertains.

      Méthodes

      À l’aide des méthodes décrites dans l’Evidence for Policy and Practice Information and Co-ordinating Centre (Centre d’information et de coordination de la politique et la pratique fondées sur des preuves), nous avons fouillé de manière systématique 7 banques de données pour examiner et faire la synthèse des données probantes sur les interventions en matière de prise en charge autonome chez les femmes ayant des douleurs d’origine cardiaque et des équivalents de la douleur d’origine cardiaque, comme la fatigue, la dyspnée et l’épuisement.

      Résultats

      Notre recherche a permis d’obtenir 22 402 titres d’articles et résumés. Parmi ceux-ci, nous avons inclus 57 essais cliniques à répartition aléatoire à la synthèse narrative finale, qui était constituée des données de 13 047 participants, dont celles de 5299 (41 %) femmes. Les interventions en matière de prise en charge autonome qui visaient la douleur d’origine cardiaque chez les femmes par rapport à la population témoin ont favorisé la réduction de : 1) la fréquence de la douleur d’origine cardiaque et la proportion de douleurs cardiaques (coronaropathies obstructives et non obstructives); 2) la fatigue après 12 mois; 3) la dyspnée après 2 mois. Il n’existait aucune donnée probante sur les différences entre les groupes en ce qui concerne la douleur après les interventions (intervention coronarienne percutanée ou chirurgie cardiaque). Les résultats ont montré que les interventions en matière de prise en charge autonome de la douleur d’origine cardiaque étaient plus efficaces si elles comportaient une plus grande proportion de femmes (différence moyenne standardisée [DMS], −0,01 ; erreur type, 0,003 ; P = 0,02), la quantification des objectifs (DMS, −0,26 ; intervalle de confiance [IC] à 95 %, −0,49 à −0,03), et la collaboration et le soutien des fournisseurs de soins de santé (DMS, −0,57 ; IC à 95 %, −1,00 à −0,14).

      Conclusions

      Les résultats de cette revue montrent que les interventions en matière de prise en charge autonome favorisent la réduction de la douleur d’origine cardiaque et des équivalents de la douleur d’origine cardiaque.
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