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

Michael McGillion1*, Sheila O’Keefe-McCarthy2, Sandra L Carroll1, J Charles Victor2, Tammy Cosman3, Allison Cook3, John G Hanlon2, E Marc Jolicoeur4, Noorin Jamal2, Robert McKelvie13 and Heather M Arthur13

Author Affiliations

1 Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSC 2J20A, Hamilton, ON L8S 4K1, Canada

2 University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada

3 Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, N3L 2Y6, Canada

4 Montreal Heart Institute, 5000, Bélanger Street, Montréal, QC H1T 1C8, Canada

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BMC Cardiovascular Disorders 2014, 14:14  doi:10.1186/1471-2261-14-14

Published: 1 February 2014



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.

Stable angina; Self-management; Health-related quality of life