By Sylvia Foley, AJN senior editor
Cellphone macro by Cubosh, via Flickr
Myocardial revascularization, an established treatment for coronary heart disease, is currently done via either percutaneous coronary intervention or coronary artery bypass graft surgery. But recovery and rehabilitation can be hard going, and patients need close monitoring. Investigators Rejane K. Furuya and colleagues wanted to learn more about the use of telephone follow-up with such patients. To that end, they searched the literature, identified relevant studies, and assessed and synthesized the results. In this month’s original research CE, “Telephone Follow-Up for Patients After Myocardial Revascularization: A Systematic Review,” they report on their findings. Here’s a short summary.
The review was conducted in accordance with the Cochrane method. The researchers searched six electronic databases for articles on clinical trials that studied patients after myocardial revascularization using telephone follow-up and were published in English, Spanish, or Portuguese. Of 170 identified studies, seven met the inclusion criteria and were analyzed.
Some findings. Both the purposes and contents of telephone follow-up varied in the analyzed studies. The researchers found that the contents could be grouped into four themes—cardiovascular illness; postoperative complications; self-care, including behavioral and lifestyle changes; and psychosocial evaluation and emotional support. Outcome measures also varied widely, but included health-related quality of life, pain, enrollment in cardiac rehabilitation programs, physical functioning, hospital readmission, mood symptoms, and medication compliance. Telephone follow-up was found to be “an effective intervention for most of the outcomes assessed.”
The researchers also explored various elements of telephone follow-up, such as the timing of follow-up, the number of calls made, and who was responsible for initiating calls. They noted that
in five of the seven analyzed studies, nurses performed the telephone follow-up; and in all five the content was more comprehensive, covering both education and counseling for patients discharged after myocardial revascularization.
Furuya and colleagues concluded that the findings support the use of telephone follow-up “to periodically assess patient knowledge, discuss patient concerns and offer help in addressing them, monitor mood symptoms and anxiety levels, and encourage behavioral and lifestyle changes.” But more research is needed to identify the optimal content and frequency, number, and duration of calls.
For full details, please read the article—it’s free online. And as always, we welcome your comments!
Using the JADAD scale to assess methodological is (I quote)
“[…] explicitly discouraged. As well as suffering from the generic problems of scales, it has a strong emphasis on reporting rather than conduct, and does not cover one of the most important potential biases in randomized trials, namely allocation concealment” (Chapter 8.3.3 of the Cochrane Handbook: http://handbook.cochrane.org/ )
I do not read about the ‘assessment of risk of bias’, as described in the Cochrane handbook.
Also, the selection of studies after screening titles and abstracts isn’t described to the fullest: although it might be acceptable that only one person screens titles and abstracts, it’s clear that a minimum of two should review the full-text articles and decide about inclusion. Was this done?
Lastly, I miss a GRADE table.
Considering these points (there might well be more) I do have serious doubts on the way this systematic review came into being. When that’s not clear it’s of little use to consider the outcomes.