projec

(database) ex: Cochran

Study #1

Study #2

Study #3

Study #4

Study #5

Synthesis

(p) Population

Men and women between 25 and 60

Patients with CAD of all genders and age

Patients with CAD of all genders and age

Ninety patients with CAD of mean age 59.2 years

Adults ≥65 years of age

Patients with CAD of all genders and age

(i) Intervention

Health teaching about proper nutrition plan for patients with CAD

Healthy dieting approach

Fractional flow reserve – guided strategy

A mobile health intervention

Healthy dieting approach

Healthy dieting approach and outcomes monitoring

(c) Comparison

No health teaching

Unhealthy diet

No use of fractional flow reserve – guided strategy

No use of a mobile health intervention

Unhealthy diet

Unhealthy lifestyle

(o) Outcome

Decrease of risks to develop CAD in vulnerable individuals by 24%

Researcher found that regular telephone support interventions may help reduce feelings of anxiety and depression as well as, improve systolic blood pressure control and the likelihood of smoking cessation to decrease the risks of cardiovascular disease progression

Use of fractional flow reserve – guided strategy is more effective for monitoring of health status in patients with CAD

Use of a mobile health intervention promote medication adherence for patients with coronary heart disease

DASH-related diets have as much as a 29% protective effect against heart failure risks

Healthy dieting approach reduces risk of CAD.

(t) time

7 years

1 year

5 years

30 days

over 21.5 years

6.9

Citation

Design

Sample size: Adequate?

Major Variables:

Independent Dependent

Study findings: Strengths and weaknesses

Level of evidence

Evidence Synthesis

Fung et al. (2016)

Quantitative, a prospective analysis

6817, adequate

Independent – dieting approach; Dependent – incidence of CAD

Using food-frequency questionnaires, researchers have found that incidence of CAD is decreasing in patients with healthier nutrition habits. The strength is using of adequate research instrument. The limitations are lack of availability of confounding factors such as patient’s functional status, severity of existing comorbid conditions, and use of medications in treatment plans.

Level I

The study that used 3 large cohort studies within the U.S. found that a higher food-based diet quality score was correlated with lower risk of coronary artery disease (Fung et al., 2016). This study is particularly interesting because it is established on the basis that there are few diet quality assessment tools that do not require considerable time and analysis in the prediction of CAD risk; the study is thus aimed at guiding the development of such tools by proving a more convenient methodology by which to analyze CAD risk through dietary quality.

Kotb, Hsieh & Wells (2014).

Quantitative study using literature review method

Irrelevant

Independent – dieting approach; Dependent – incidence of CAD

The study shows that telephone support in interventions for CAD in patients who had already experienced a cardiac event is very promising. The study involved a systematic review and meta-analysis of 26 unique studies, and the results indicated that while there were no differences in mortality rates between the telephone and control groups indicating a similar level of efficacy), the telephone groups actually exhibited significantly fewer hospitalizations, improved rates of smoking cessation, lower systolic blood pressure, lower depression scores, as well as lower anxiety scores (Koth, Hsieh & Wells, 2014). Limitations include use of old studies along with the recent ones.

Level III

While the DASH diet and dietary methods have some degree of support within professional literature, even if it is not widely consistent, another issue associated with the type of intervention for this study, which seeks to educate patients, is how to best ensure compliance. As heart diseases in general become a wider issue, the problem of maintaining patient participation in provision of care remains steady, even in cases where patients have already experienced an adverse cardiac event (Kotb et al., 2014).

Lee, Doh, Nam, Shin, & Koo (2018).

Quantitative study using literature review method

Irrelevant

Independent – fractional flow reserve – guided strategy; Dependent – CAD status monitoring

The study found that fractional flow reserve – guided strategy is effective for monitoring of health outcomes in patients with CAD. The main strength of this study is using articles from a long period of five years. The main limitations are implementation of ambiguous statistical instrument for counting and data analysis and slow development of invasive coronary physiology technologies resulting in omissions during data collection process.

Level IV

The study by Lee et al. (2018) will be implemented to make conclusions regarding importance of regular screening in patients with CAD to monitor their health status and offer timely interventions.

Park, Howie-Esquivel, Chung, & Dracup, (2014)

Quantitative, a randomized controlled trial

90, quite adequate

Independent – medication reminders and education; Dependent – health status in patients with CAD

This study indicated that patients tended to exhibit higher degrees of accuracy in their level of compliance (for example, the experimental group more frequently took correct dosages and stayed on schedule) (Park et al., 2014), suggesting that text messages could also be a viable method of encouraging compliance with the dietary modifications. The main strength of the study is use of ANOVA because the sample size is quite small. The limitation is that data collection process took only 30 days, which is not enough to consider all possible variants.

Level II

The overall self-reported adherence did not differ significantly between groups that received medication reminders and educational texts, educational text messages only, or no text messages at all (Park et al., 2014). So, text messaging and phone support may be potentially constructive supplements, but they are unlikely to be effective eon their own. However, utilizing both methods may be even more effective than using either method independently.

Del Gobbo et al. (2015)

Quantitative study, prospective analysis

4,490, adequate

Independent – dieting approach; Dependent – incidence of CAD

Coronary heart disease showed only 21% reduction is risk with dietary changes. The main strength is using prospective data obtained during the period of over 21 years. The main limitation is use of only one statistic tool to perform data analysis.

Level II

A successful reduction in various contributing factors to heart failure would result in a wider reduction in risk of heart failure. Diets play an important role in addressing CAD (Del Gobbo et al., 2015).