Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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European journal of cardiovascular nursing
The psychological effects of interventions targeting informal caregivers of patients with cardiovascular disease-a systematic review.
AIMS: To explore the psychological effects of interventions aimed at supporting informal caregivers involved in the care and treatment of patients with cardiovascular disease. METHODS AND RESULTS: Databases (PubMed, CINAHL, Embase, Cochrane Library, and PsycInfo) were searched for studies in accordance with the Cochrane Handbook guidelines. Inclusion criteria were: caregivers of patients with one or more cardiovascular diseases, patient and caregiver >18 years, caregivers included in the intervention, and, reporting of psychological outcomes specific to caregivers. Study designs were randomized controlled trials with a follow-up periods of >2 months. The RoB 2.0 bias assessment tool was used to assess risk of bias. Fifteen studies from nine countries were identified. Most interventions consisted of multiple components including educational face-to-face sessions, telephone support, and/or written resources. The analysis showed inconsistent results on caregiver outcomes, but significant improvements were reported in eight studies in at least one caregiver outcome. Analysis indicated that the studies providing more frequent contact with caregivers and patients were more likely to report significant improvements in caregiver outcomes. Risk of bias was judged as low in three studies, some concerns in nine studies, and as high in three studies. CONCLUSION: Due to inconsistency in results, this review yield uncertainty about whether interventions targeting caregivers of patients with cardiovascular disease improve caregivers' psychological outcomes. Therefore, further research is needed to develop effective interventions for caregivers, as they play a vital role in the daily care and treatment of patients with cardiovascular disease. REGISTRATION: PROSPERO: CRD420250654618.
17 July 2026
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A review and promise of digital health technologies to promote global cardiovascular health
Digital health technologies include an array of mobile or digital devices and apps that may be used by patients to support lifestyle modification or medical apps that monitor vital parameters and provide data that may influence treatment decisions. The use of digital health technologies is a growing opportunity for disease prevention and management of cardiovascular disease (CVD) for both patients to engage in self-management as well as nurses to monitor patients remotely and facilitate clinical decision support. The aims of this review article are to provide an overview of pertinent digital health technologies in CVD care, address social determinants of health and other enablers/barriers to digital health implementation, and provide perspectives on novel models of care incorporating digital technologies. Based on the latest evidence, recommendations for special considerations and implementation of digital health technologies in low- and middle- vs high-income countries are presented. In addition, tables reviewing functionality of the digital tools and global examples of their use are provided. Extensive empirical evidence from diverse populations suggests adoption of these innovative tools has been low in clinical settings. We provide a table summarizing these barriers and include the facilitators that can improve the adoption of digital health tools to improve behavioral lifestyle modification. For learning purpose, implementation of an innovative model of care is illustrated graphically and in text. We include a call to action to achieve the maximum impact of digital technology to support nurses who work in almost all settings improving CVD prevention and management globally. The multiple roles of nurses using digital health for global CVD prevention and management are discussed in the settings of clinical practice, research, education, public health, health policy/leadership, and informatics.
5 Apr 2026
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Effects of personalized structured telemedicine-based exercise cardiac rehabilitation on health outcomes in patients with coronary heart disease: a systematic review and meta-analysis
AIMS: Despite its proven effectiveness, traditional exercise-based cardiac rehabilitation (exCR) suffers from low participation rates. However, telemedicine-based exCR can overcome access barriers to traditional rehabilitation while providing personalized, structured exercise training and remote monitoring. The aim of this review is to ascertain the efficacy of personalized, structured, telemedicine-based exCR in improving health outcomes in patients with coronary heart disease (CHD). METHODS AND RESULTS: A systematic search was conducted in databases including Cochrane Library, PubMed, Web of Science, Embase, CINAHL, Scopus, Medline, China National Knowledge Infrastructure, Wanfang, VIP, and SINOMED from inception to March 2024 to identify randomized controlled trials (RCTs). The final analysis included 19 RCTs comprising 2219 participants. Among patients with CHD, telemedicine-based exCR demonstrated comparable effects to centre-based exCR across multiple outcomes, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life (all P > 0.05). Notably, when compared with usual care, telemedicine-based exCR showed significant improvements in exercise capacity [standardized mean difference (SMD) = 0.23, 95% CI: (0.12, 0.35), I2 = 34%, P < 0.0001], physical activity level [SMD = 0.32, 95% CI: (0.09, 0.54), I2 = 53%, P = 0.006], diastolic blood pressure [mean difference (MD) = -1.54, 95% CI: (-2.89, -0.20), I2 =8%, P = 0.02], body mass index [MD = -0.54, 95% CI: (-1.94, -0.14), I2 = 4%, P = 0.008], and depression [SMD = -0.27, 95% CI: (-0.42, -0.13), I2 = 33%, P = 0.0002]. CONCLUSION: Telemedicine-based exCR is equally effective as centre-based exCR in improving key health outcomes for patients with CHD, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life. Furthermore, telemedicine-based exCR shows superior effectiveness to usual care, with statistically significant improvements in exercise capacity, physical activity, diastolic blood pressure, and depressive symptoms. REGISTRATION: PROSPERO: CRD42024521465.
5 Apr 2026
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