Table 2 General characteristics of the included studies (N = 29)
# | Author | Country | Year | Number of participants, mean age, gender | Study participants | Study design and duration | Content of patient education and theory | Applied intervention | Main finding | Key effects | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Bjørnnes, A. K.[12] | Norway | 2017 | ♦ 416 participants (23% women), M &F | ♦ Patients > 18 years of age, able to read and write Norwegian and scheduled for elective coronary artery bypass surgery (CABG) and/or valve surgery were consecutively invited to participate in the study from March 2012 through to September 2013 | Randomized controlled trial, From March 2012 to September 2013 | Educational pain management booklet | Booklet and telephone | ♦ The pain intensity did not decrease compared to the control | ♦ Patient care improvement | • No statistically significant differences between the groups were observed in terms of the outcome measures following surgery |
2 | Cook, D. J.[22] | United States | 2014 | ♦ 149 patients with a mean age of 68 years | ♦ Utilized 5,267 of 6,295 (84%) Patients were provided with iPad® (Apple ®, Cupertino, CA) tablets that delivered educational modules as part of a daily "to do" list in a plan of care | Observational study without control | Educational modules as part of a daily "to do" list in a plan of care | Mobile application | ♦ The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and "just-in-time" education in a highly consumable format | ♦ Patient care improvement | • Mobile phone or tablet can be effective in educating the patient |
3 | De Oliveira, A. P. A.[23] | Brazil | 2016 | ♦ 90 patients, 45 in each group, mean age was 61.64 yrs. in CG and 63.87 yrs. in IG, most comprising male patients (68.9%) | ♦ Patients undergoing myocardial revascularization (CABG) surgery | Randomized controlled trial, from May 2012 to August 2013 | Bedside orientation | Video resources | ♦ Orientation performed with the aid of video resources is more effective for knowledge retention in preoperative patients, compared to verbal orientation alone | ♦ Patient knowledge improvement | • The use of video resources such as short films and slides can be effective in educating patients |
4 | Fredericks, S.[24] | Canada | 2013 | ♦ 33 patients, the mean age was 66 ± 10 years (range:32–88 years) | ♦ Study participants who had suffered a myocardial infarction, underwent revascularization, or who had angina pectoris or coronary heart disease. Individuals who underwent CABG or VR were underrepresented | A descriptive study, the first three months of recovery | Post-operative program | Telephone | ♦ Increasing the number of times education is provided may reduce the number of hospital readmissions | ♦ Reduction in hospital readmissions ♦ Reduction in cost of care | • Teaching the patient self-care after heart surgery reduces the likelihood of recurrence |
5 | Guo, P.[18] | United Kingdom | 2012 | ♦ 153 adult patients, Mean (SD) age in years 52.3 (15.99) 52.0 (16.12) | ♦ Elective cardiac surgery were eligible for the trial if they were able to speak, read, and write Chinese. Cardiac surgery included coronary artery bypass grafting, valve surgery, congenital and other open-heart surgery | Randomized controlled trial, From March 2012 to September 2013 | Usual care plus an educational booklet at discharge with supportive telephone | Booklet and telephone | ♦ This form of preoperative education is effective in reducing anxiety and depression among Chinese cardiac surgery patients | ♦ Reduction of patients' depression and anxiety | • Preoperative education is effective in reducing patients' stress and anxiety |
6 | Hoseini, S.[8] | Iran | 2013 | ♦ 70 patients, Mean and standard deviation of age in the intervention and control groups were 60. 86 ± 9 45 and 59 77 ± 7 29 | ♦ Undergoing CABG surgery in two hospitals in Shiraz. The patients were divided into two equal groups, the control and intervention | Randomized controlled trial, six weeks | Educational program after surgery | Audiotape | ♦ The mean scores obtained in both anxiety and depression dimensions were significantly different between the intervention and control groups | ♦ Patient satisfaction improvement | • Audio tape containing postoperative training is effective in-patient self-care |
7 | Kadda, O.[25] | Greece | 2016 | ♦ 250 patients, Intervention Group (Age): Men (n = 184) Women (n = 65), (years): Men (64.2 yrs.) Women (70 yrs.) ♦ Control Group (Age): Men (n = 187) Women (n = 63), (years): Men (62.8yrs) Women (66.7 yrs.) | ♦ Valvular heart disease from different causes, like endocarditis, rheumatic heart disease, or replacement with combined CABG) | Randomized, nonblind intervention, with 1-year follow-up | Specific educational information for postoperative rehabilitation | Booklet | ♦ Lifestyle nursing intervention immediately after open heart surgery had a beneficial effect on men 1 year after the surgery but not on women | ♦ Lifestyle changes | • Educating patients about postoperative care and lifestyle and heart rehabilitation by nurses can be effective in the healing process |
8 | Lai, V. K. W.[26] | Hong Kong | 2021 | ♦ 100 (50 treatment, 50 control) patients and ♦98 (49 treatment, 49 control) family members, ♦94 (48 treatment, 46 control) patients ♦ 94 (47 treatment, 47 control) family members completed the trial | ♦ Elective coronary artery bypass grafting valve surgery patients and their family members | Randomized controlled trial, From September 2015 to August 2017 | Structured information in a preoperative video and ICU tour | Video resources | ♦ Providing comprehensive preoperative information about ICU to elective cardiac surgical patients improved patient and family satisfaction levels and may decrease patients' anxiety levels | ♦ Patient satisfaction improvement ♦ Reduction of patients' depression and anxiety | • Preoperative education of the patient and the patient's family can be effective in the patient's recovery process and reduce anxiety |
9 | Lai, V.K.W.[27] | Hong Kong | 2016 | ♦ 100 patients (50 patients in each group) | ♦ Patients undergoing elective cardiac surgery on patient and family satisfaction with care and decision-making in the ICU | Randomized controlled trial, 30 days | A preoperative patient education intervention | Video resources | ♦ Preliminary results indicated that patients and their families were satisfied with the training on care, and secondary results indicated a reduction in anxiety | ♦ Patient satisfaction improvement ♦ Reduction of patients' depression and anxiety | • Preoperative education for patients and their families will improve the performance of postoperative care and reduce their anxiety |
10 | Lowres, N.[28] | Australia | 2016 | ♦ 42 participants (mean age 69 ± 9 years, 80% male) | ♦ They had no prior history of atrial fibrillation (AF) and were discharged home in stable sinus rhythm | Cross sectional study, March 2014 and July 2015 | 5- to 10-min practice session was required to successfully learn to use the iECG | Educational module on handheld portable ECGs | ♦ Using this technology can help reduce the recurrence of the disease and control stress to the patient | ♦ Reduction of patients' depression and anxiety | • New technologies in the field of self-care for patients help Anna and their families in controlling illness and stress |
11 | Martorella, G.[29] | Canada | 2013 | ♦ 30 patients, 20% of women and 80% of men with a mean age of 65 years | ♦ Adults undergoing cardiac surgery, to promote the self-management of postoperative pain | Observational study without control, over 4 months in 2010 | The development and validation of a tailored Web-based intervention for postoperative pain self-management in adults who underwent cardiac surgery | Virtual environment | ♦ Patient empowerment is complementary yet crucial in the current context of care and may contribute to improved pain relief | ♦ Patient care improvement | • The use of new information technologies can personalize patient care and provide more complete patient care |
12 | McGillion, M.[30] | Canada | 2020 | ♦ 11 patients, all patients were over 65 years of age, the majority of patients were male | ♦ Patients recovering from cardiac or major vascular surgery | Randomized controlled trial, 30 days | Educational program after surgery | Virtual environment | ♦ The need for additional opportunities to practice in order to become comfortable and proficient in the use of these systems | ♦ Clinical practice Change | • The use of new remote care technologies will create personalized and continuous care |
13 | Melholt, C.[31] | Denmark | 2018 | ♦ 49 cardiac patients, mean age of 60.64 ± 10.75 years, and 82% of the respondents were males | ♦ Cardiac patients | Observational study without control, September 2014 and February 2015 | Not mentioned | The interactive ‘Active Heart’ web portal | ♦ The patients’ eHealth literacy skills increased during the trial period | ♦ Patient care improvement | • Distance and online education can be effective in increasing self-care and rehabilitation skills after heart surgery |
14 | Moghimian, M.[32] | Iran | 2019 | ♦ 80 patients, age range between 40 and 70 years | ♦ Being a candidate for coronary artery bypass graft, first time open-heart surgery, lack of cognitive problems such as dementia, lack of physical disability such as blindness or deafness, age range between 40 and 70 years | Before-after Design, study, in 2017 | Digital storytelling on the anxiety | Digital storytelling media | ♦ Storytelling in multimedia environments can reduce the tension experienced by many presurgical patients | ♦ Reduction of patients' depression and anxiety | • The use of multimedia tools is effective in educating patients and reducing their anxiety |
15 | O'Brien, L.[33] | Australia | 2013 | ♦ 375 people who had undergone cardiac surgery, (70.1%) were men and 112 (29.9%) were women, mean age 66 yrs | ♦ Patients who underwent elective cardiac surgery | Cross sectional study, in 2009–2010 | Both pre-operative written information and post-operative education relating to post-operative precautions | Booklet | ♦ Multidisciplinary written pre-surgery education appears to be providing patients with a good understanding of what to expect following surgery | ♦ Patient care improvement ♦ Reduction of patients' depression and anxiety ♦ Reduction in cost of follow up | • Providing education to patients before surgery and being aware of their expectations can lead to faster recovery and reduced anxiety |
16 | Pazar, B.[34] | Turkey | 2020 | ♦ 200 patients, 100 intervention group (77% male) ♦ Control group100 (72% male) | ♦ Preoperative education of cardiac patients on hemodynamic parameters, comfort, anxiety and patient-ventilator synchrony | Randomized controlled trial, from June 2015 to April 2016 | Preoperative education on mechanical ventilation | Brochure | ♦ The participants in the intervention group who received education had higher patient-ventilator synchrony, comfort and hemodynamic stability levels, anxiety levels when they were under mechanical ventilation, showing that results were better in the intervention group than the control group | ♦ Patient care improvement ♦ Reduction of patients' depression and anxiety | • Educating patients about ventilator use and postoperative care can reduce postoperative complications and reduce patients' anxiety |
17 | Salehmoghaddam, A.[5] | Iran | 2016 | ♦ 60 patients, means age of patients were 57.5 and 56.2 yrs. in the intervention and the control groups | ♦ All patients undergoing open heart surgery hospitalized at open heart surgery | Randomized control trial, from September 2015 to December 2015 | Instructional videos on respiratory function | Video resources | ♦ The instructional videos rather than pamphlet and face-to-face training to improve postoperative respiratory function in patients undergoing open heart surgery | ♦ Patient knowledge improvement ♦ Patient care improvement | • The use of educational videos is more attractive than face-to-face training and written materials. It is also possible to prepare different videos according to the level of education of individuals |
18 | Wakefield, B.[35] | United states | 2014 | ♦ Intervention (N = 43), Usual-care (N = 12), Mean age (yrs.) 63.7, 63.8 | ♦ Remote cardiac rehabilitation participants (n = 48) received education and assessment during 12 weeklies by telephone calls. Data were compared with those for face-to-face CR program participants | Non-randomized control trial, From August 2010 through August 2011 | Remote cardiac rehabilitation content | Telephone | ♦ Remote CR is a viable alternative to bring services closer to the patient | ♦ Hospitalization reduction | • Providing telephony-based services can reduce the need for ongoing patient care and help those who are unable to attend hospital |
19 | Pakrad, F. [36] | Iran | 2021 | ♦ Intervention group (N = 44) control group (N = 44), Age (62.6 ± 8.1,62.9 ± 9.8), Sex (Male36, Female 8), (Male38, Female6) | ♦ Patients Who Have Undergone Coronary Artery Bypass Surgery | Randomized controlled trial, from October 2019 to April 2020 | An educational booklet regarding risk factor management was provided to these participants | Booklet and telephone | ♦ The CCM was effective in not only improving the primary and secondary outcomes in this trial, but also affecting the process indicators as hypothesized. Indeed, CR participants exposed to the CCM had significantly more positive perceptions of the quality of their care and its continuity | ♦ Patient care improvement. ♦ Reduction of patients' Depression, Anxiety and Stress | • This trial demonstrates that applying the CCM to CR in a hybrid delivery model results in clinically significant improvements in QOL and functional capacity, as well as reduced rates of rehospitalization |
20 | Mayer-Berger, W. [37] | Germany | 2014 | ♦ Intervention group (N = 271) control group (N = 329), (gender): Men (n = 246), Mean age (yrs.) 49.2 ± 5.7, 49.1 ± 5.4 | ♦ Coronary artery disease (CAD) patients of low educational level compared to usual care after surgery | Randomized controlled trial, 5 years to 31 December 2010, | The contents of the educational program were selected based on literature, especially the manuals My Heart, My Life (National Heart Foundation of Australia2008) and The Heart Manual (Lothian Health Board2007) about the risk factors for CAD and correct use of medication | Telephone | ♦ Patients in the IG showed better 3-year risk profile outcomes, the PROCAM score increased by 3.0 (IG) | ♦ Patient care improvement | • This long-term secondary prevention program with inpatient rehabilitation at the beginning and telephone reminders for a 3-year period was successful. There were significant differences in health-related quality of life |
21 | Furuya, R. K. [17] | Brazil | 2014 | ♦ Intervention group (N = 30) control group (N = 30), Age (63.3, 60.6), Sex (Male 60.0, Female40.0), (Male 53.3, Female 46.7) | ♦ Sixty patients who were preparing for their first percutaneous coronary | Quasi-experimental, between August 2011–June 2012 | Booklet 1: ‘Percutaneous Transluminal Coronary Angioplasty’ Booklet 2: ‘Going home after your coronary angioplasty’ Booklet 3: ‘How to take care of your heart and your health’ | Booklet and telephone | ♦ The educational program with telephone follow-up is potentially an effective strategy to provide motivation and emotional and social support to the patient, leading to reduced anxiety symptoms with trends toward improvement in some domains of health status | ♦ Patient care improvement | • The educational program with telephone follow-up is a promising |
22 | Kalogianni, A. [38] | Greece | 2015 | ♦ Intervention group(N = 205) control group (N = 190), Age (65.9, 65.1), Sex (Male 145, Female 60), (Male 140, Female 50) | ♦ All patients admitted for elective cardiac surgery included CABG, valve replacement, ascending aortic aneurysm repair or a combination of these | Randomized controlled, from May 2011 until January 2014 | It included information about anatomy, function, and surgical diseases of the heart, the open-heart surgery, the hospital, the perioperative period and process and emphasized the self-care of patients | Booklet | ♦ The state of anxiety on the day before surgery decreased only in the intervention group | ♦ Patient care improvement ♦ Reducing readmissions or length of stay ♦ Reduction of patients' Depression, Anxiety and Stress | • Preoperative education delivered by nurses reduced anxiety and postoperative complications of patients undergoing cardiac surgery, but it was not effective in reducing readmissions or length of stay |
23 | Wang, L. W. [39] | Taiwan | 2016 | ♦ Intervention group(N = 20) control group (N = 40), Age (61.32 ± 13.4), Sex (men (66.7%) | ♦ The patients underwent first-timeCABGor heart valve surgery | Quasi-experimental study, from August to December 2010 | The intervention comprised exercise training with multimedia DVDs and printed booklets distributed by the researchers | Multimedia DVDs and printed booklets | ♦ These results suggest that our multimedia exercise training program has clinical benefits on physical activity and fitness for patients admitted to phase 1 exercise training after first-time, uncomplicated cardiac surgery | ♦ Patient care improvement | • Multimedia exercise training program safely improved distance walked in the 6MWT, heart rate recovery, and self-efficacy at hospital discharge in patients after heart surgery and maintained them improvement in 6MWT and self-efficacy 1 month later |
24 | Bikmoradi, A. [40] | Iran | 2017 | ♦ Intervention group (N = 36) control group (N = 35), Age (62 ± 7.41, 64.03 ± 7.77), Sex (Male 27, Female 9), (Male22, Female13) | ♦ Patients who had undergone CABG | Quasi-experimental study, in 2014 | Included an emphasis on education and counseling about the correct administration of medications, recommendations on diet and physical activity levels, avoiding heart disease risk factors and smoking, pain management, care of the surgical incision, maintenance of balanced mental health, and maintenance of balanced bowel movements, sleep and vital signs | Telephone | ♦ There was significant and positive deference between the two groups in favor of the telephone counseling after the intervention | ♦ Patient care improvement ♦ Patient satisfaction improvement | •Telephone counseling could be a cost-effective patient counseling plan for therapeutic adherence after coronary artery bypass surgery in order to improve the patients’ quality of life |
25 | Widmer, R. J. [15] | USA | 2017 | ♦ Intervention group (N = 37) control group (N = 34), Age (62.5 ± 10.7, 63.6 ± 10.9), Sex (Male29), (Male29) | ♦ Patients entering three months of Mayo Clinic CR after heart surgeries randomized in a 1:1 fashion via computer generated sequence to standard CR versus standard CR + DHI | Randomized clinical trial, from august 2013 and February 2015 | Cardiac rehabilitation platform asking the patients to report of dietary and exercise habits throughout CR as well as educational information toward patients' healthy lifestyles | Mobile application | ♦ CR platform asking the patients to report of dietary and exercise habits throughout CR as well as educational information toward patients' healthy lifestyles | ♦ Patient care improvement ♦ Patient knowledge improvement | • The study suggests a role for DHI as an adjunct to CR to improve secondary prevention of CV disease |
26 | Coskun, H. [41] | Turkey | 2016 | ♦ Intervention group (N = 90) control group (N = 90), Age (66 ± 3, 50 ± 9), Sex (Male 64, Female 26), (Male60, Female30) | ♦ Patients who underwent cardiovascular surgery | Randomized clinical trial, from November 2011 and June 2012 | Discharge education | Booklet | ♦ Both written and verbal discharge training increased the knowledge levels | ♦ Patient care improvement ♦ Hospitalization reduction ♦ eduction in cost of care | • To solve the problems after discharge, which may reduce the number of patients presenting at hospital and in turn, related healthcare costs |
27 | Ramesh C. [21] | India | 2020 | ♦ Intervention group (N = 65) control group (N = 65), Age (57.62, 57.46), Sex (Male55, Female 10), (Male53, Female 12) | ♦ Patients with CABG surgery | Randomized controlled trial, six months in 2018 | The health promotion model (HPM) seeks to enhance one’s health and well-being. The HPM concentrates on the following three areas: (i) Individual characteristics and experiences, (ii) behavior-specific cognitions, and (iii) behavioral outcomes | Video resources | ♦ Nurses should use well-structured content to teach patients before CABG surgery and spend enough time on patient education regular | ♦ Reduction of patients' Depression, Anxiety and Stress ♦ Patient care improvement | • Patient education effectively decreases anxiety, pain, and fatigue and improves self-efficacy and quality of life in patients undergoing CABG surgery |
28 | Fahimi, K. [42] | Iran | 2018 | ♦ Intervention group (N = 55) control group (N = 55), Age (57.84 ± 13.117, 57.69 ± 11.23), Sex (Male28, Female 27), (Male28, Female 27) | ♦ The inclusion criteria were experiencing the coronary artery bypass graft for the first time and non-development of postoperative cardiogenic shock or myocardial rupture | Randomized clinical trial, in 2016 | Multimedia education on postoperative delirium in patients undergoing a coronary artery bypass graft | Booklet/The mobile application | ♦ The results indicated that the highest incidence of delirium was observed on the first day after surgery in the intervention group (7.3%) and on the morning of the second day after surgery (14.5%) in the control group | ♦ Reduction of patients' post-operative delirium | • Considering the lower incidence of post-operative delirium in patients who experienced multimedia education rather than control group, the use of this non-pharmaceutical method is recommended to prevent delirium in such patients |
29 | Fredericks, S. [43] | Canada | 2013 | ♦ Experimental group (N = 17) control group (N = 17) Mean age (yrs.) 66.2, 65.6 ± 8.3; men (77.8%) | ♦ CABG and/or VR surgery for the first time, spoke English; To had access to a working phone following hospital discharge | Randomized controlled trial, 3 months | The topic areas identified on the PLNS (Patient Learning Needs Scale) are reflective of CABG and VR patients’ learning needs | Telephone | Educational patients to reduce the number of hospital readmissions and complications at three months following hospital discharge | ♦ Patient care improvement ♦ Reducing readmissions or length of stay | An impact on reducing hospital readmission rates and complications during the initial home recovery period |