Interventions to Promote Dietary Self-Management Behaviors Among Acute Coronary Syndrome Patients with Comorbidities: A Systematic Review
Keywords:
Acute coronary syndrome, Comorbidity, Dietary behavior, Self-management program, Systematic reviewAbstract
Dietary self-management behaviors can reduce the risk of recurrent events in patients with acute coronary syndrome (ACS), especially among those with comorbidities. However, promoting and sustaining these behaviors remains a significant challenge in ACS management. This systematic review aimed to summarize the findings of studies on interventions to promote dietary self-management behaviors in ACS patients with comorbidities. It follows the Joanna Briggs Institute's systematic review guidelines, focusing on studies published between 2014 and 2024 which included randomized controlled trials and quasi-experimental studies on interventions to promote dietary self-management in ACS patients with comorbidities. Eight studies met the inclusion criteria and passed the quality assessment. The reviewed studies demonstrated diversity in intervention design, data collection, and outcome evaluation. Therefore, a content analysis was conducted.
The results of this systematic review found that
1. Five interventions for promoting dietary self-management behaviors included 1) Providing knowledge and individual consultation, 2) Recording and monitoring self-behavior, 3) Motivational enhancement, 4) Social and family support, and 5) Use of digital technology and mobile applications.
2. Outcomes of those interventions included: 1) Physical health: Favorable biochemical changes, including increased HDL, decreased LDL, total cholesterol, FBS, and reduced BMI; 2) Psychosocial: Positive attitude development, enhanced self-efficacy, and increased motivation, contributing to sustained behavioral changes; and 3) Self-control: Improved dietary self-management behaviors.
This systematic review recommends that further primary research be conducted on interventions aimed at promoting dietary self-management behaviors in patients with ACS and comorbidities. Such research would generate evidence-based data to identify the most effective and appropriate strategies for supporting dietary self-management in this patient population.
References
Akhu Zaheya, L. M., & Shiyab, W. Y. (2017). The effect of short message system (SMS) reminder on adherence to a healthy diet, medication, and cessation of smoking among adult patients with cardiovascular diseases. International Journal of Medical Informatics, 98, 65–75. https://doi.org/10.1016/j.ijmedinf.2016.12.003
Amini, R., Rajabi, M., Azami, H., & Soltanian, A. (2021). The effect of self-management intervention program on the lifestyle of post myocardial infarction patients. Journal of Education and Health Promotion, 10, 145. https://doi.org/10.4103/jehp.jehp_902_20
Andrikopoulos, G., Tzeis, S., Nikas, N., Richter, D., Pipilis, A., Gotsis, A., Tsaknakis, T., Kartalis, A., Kitsiou, A., Toli, K., Mantas, I., Olympios, C., Pras, A., Lampropoulos, S., Oikonomou, K., Pappas, C., Kranidis, A., Anastasiou-Nana, M., Triposkiadis, F., … Vardas, P. (2013). Short-term outcome and attainment of secondary prevention goals in patients with acute coronary syndrome--results from the countrywide TARGET study. International Journal of Cardiology, 168(2), 922–927. https://doi.org/10.1016/j.ijcard.2012.10.049
Arunsang, P. (2017). Nursing care of patients with cardiovascular disease (11th ed.). Khlangnavaithaya Press. (in Thai)
Badimon, L., Chagas, P., & Chiva Blanch, G. (2019). Diet and cardiovascular disease: Effects of foods and nutrients in classical and emerging cardiovascular risk factors. Current Medicinal Chemistry, 26(19), 3639–3651. https://doi.org/10.2174/0929867324666170428103206
Balaha, M. F., Alamer, A. A., Kabel, A. M., Aldosari, S. A., & Fatani, S. (2023). A prospective cross sectional study of acute coronary syndrome patients’ quality of life and drug prescription patterns at Riyadh Region Hospitals, Saudi Arabia. Healthcare (Basel, Switzerland), 11(13), 1973. https://doi.org/10.3390/healthcare11131973
Brunori, E. H. F. R., Lopes, C. T., Cavalcante, A. M. R. Z., dos Santos Romualdo Silva, M. C., de Lima Lopes, J., & de Barros, A. L. B. L. (2015). Dietary intake and stress in patients with acute coronary syndrome. Revista Brasileira de Enfermagem, 68(5), 528-534. https://doi.org/10.1590/0034-7167.2015680507i
Chinphan, S., Sirisophon, N., Onseri, S., & Watthanaburanont, E. (2019). Factors correlated with instent restenosis in coronary heart disease patients. Journal of The Royal Thai Army Nurses, 20(3), 218–226. https://he01.tci-thaijo.org/index.php/JRTAN/article/view/187485 (in Thai)
Cruz Cobo, C., Bernal Jiménez, M. Á., Calle, G., Gheorghe, L. L., Gutiérrez Barrios, A., Cañadas, D., Tur, J. A., Vázquez García, R., & Santi Cano, M. J. (2024). Efficacy of a mobile health app (eMOTIVA) regarding compliance with cardiac rehabilitation guidelines in patients with coronary artery disease: Randomized controlled clinical trial. JMIR mHealth and uHealth, 12, e55421. https://doi.org/10.2196/55421
Fatahian, F., Mohammadifard, N., Hassanzadeh, A., & Shahnazi, H. (2024). The effect of a health belief model–based education on nutritional behavior and biochemical factors of patients with myocardial infarction: A line follow up experimental study. Health Science Reports, 7(3), e1966. https://doi.org/10.1002/hsr2.1966
Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., Goldberg, R., Heidenreich, P. A., Hlatky, M. A., Jones, D. W., Lloyd-Jones, D., Lopez-Pajares, N., Ndumele, C. E., Orringer, C. E., Peralta, C. A., … Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: Executive summary: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Journal of the American College of Cardiology, 73(24), 3168-3209. https://doi.org/10.1016/j.jacc.2018.11.002
Joanna Briggs Institute. (2023). The critical appraisal tool. https://jbi.global/critical-appraisal-tools
Lizcano Álvarez, Á., Carretero Julián, L., Talavera Sáez, A., Cristóbal Zárate, B., Cid Expósito, M. G., Alameda Cuesta, A., & REccAP Group. (2023). Intensive nurse led follow up in primary care to improve self management and compliance behaviour after myocardial infarction. Nursing Open, 10(8), 5211–5224. https://doi.org/10.1002/nop2.1758
Luisi, M. L., Biffi, E., Gheri, C. F., Sarli, E., Rafanelli, E., Graziano, E., Vidali, S., Fattirolli, F., Gensini, G. F., & Macchi, C. (2015). Efficacy of a nutritional education program to improve diet in patients attending a cardiac rehabilitation program: Outcomes of a one-year follow-up. Internal and Emergency Medicine, 10(6), 671–676. https://doi.org/10.1007/s11739-015-1211-y
Ministry of Public Health, Department of Disease Control, Noncommunicable Diseases Division. (2024). Number and mortality rates of the five noncommunicable diseases (NCDs), 2018–2022. https://www.ddc.moph.go.th/dncd/news.php?news=39911 (in Thai)
Mosleh, S. M., & Darawad, M. (2015). Patients' adherence to healthy behavior in coronary heart disease: Risk factor management among Jordanian patients. Journal of Cardiovascular Nursing, 30(6), 471–478. https://doi.org/10.1097/JCN.0000000000000189
Mozaffarian, D. (2016). Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: A comprehensive review. Circulation, 133(2), 187–225. https://doi.org/10.1161/CIRCULATIONAHA.115.018585
Nunthaitawweekul, P., & Pansup, J. (2021). The effect of a self-management program combined with social support on the self-management and healthy eating behaviors among patients with cardiovascular disease. Walailak Journal of Science and Technology, 18(4), 9614. https://doi.org/10.48048/wjst.2021.9614 (in Thai)
Rokhmah, L., Kurniawati, N. D., & Nastiti, A. A. (2020). The relationship of family support and self-efficacy with diet compliance in patients with coronary heart disease. EurAsian Journal of BioSciences, 14(1), 1669–1672.
Tantikittichaiyakun, K., Sriprasong, S., Wattanakitkrileart, D., & Srimahachota, S. (2024). The effect of a self management program through the LINE application on self management in people with acute coronary syndrome. Thai Journal of Nursing, 73(2), 12–21. https://he02.tci-thaijo.org/index.php/TJN/article/view/265488 (in Thai)
Teleki, S., Zsido, A. N., Komocsi, A., Lenard, L., Kiss, E. C., & Tiringer, I. (2019). The role of social support in the dietary behavior of coronary heart patients: An application of the health action process approach. Psychology, Health & Medicine, 24(6), 714–724. https://doi.org/10.1080/13548506.2018.1550259
Thuajop, S., Maneesriwongkul, W., & Disamoe, S. (2024). Relationships of knowledge, health literacy, and preventive behaviors among persons at risk for coronary artery disease. Journal of Thailand Nursing and Midwifery Council, 39(3), 342–356. (in Thai)
Tian, Y., Li, D., Cui, H., Zhang, X., Fan, X., & Lu, F. (2024). Epidemiology of multimorbidity associated with atherosclerotic cardiovascular disease in the United States, 1999–2018. BMC Public Health, 24(1), 267. https://doi.org/10.1186/s12889-023-17619-y
Timmis, A., Vardas, P., Townsend, N., Torbica, A., Katus, H., De Smedt, D., Gale, C. P., Maggioni, A. P., Petersen, S. E., Huculeci, R., Kazakiewicz, D., de Benito Rubio, V., Ignatiuk, B., Raisi-Estabragh, Z., Pawlak, A., Karagiannidis, E., Treskes, R., Gaita, D., Beltrame, J. F., … Atlas Writing Group, European Society of Cardiology (2022). European Society of Cardiology: Cardiovascular disease statistics 2021. European Heart Journal, 43(8), 716-799. https://doi.org/10.1093/eurheartj/ehab892
Wang, H., Zhao, T., Wei, X., Lu, H., & Lin, X. (2019). The prevalence of 30-day readmission after acute myocardial infarction: A systematic review and meta-analysis. Clinical Cardiology, 42(10), 889–898. https://doi.org/10.1002/clc.23238
World Health Organization [WHO]. (2024). Noncommunicable diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Zhang, F., Mohamed, M. O., Ensor, J., Peat, G., & Mamas, M. A. (2020). Temporal trends in comorbidity burden and impact on prognosis in patients with acute coronary syndrome using the Elixhauser Comorbidity Index score. The American Journal of Cardiology, 125(11), 1603–1611. https://doi.org/10.1016/j.amjcard.2020.02.044
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