Summary of findings 4. Combined interventions compared to usual care for people with coronary heart disease.
| Combined interventions compared to usual care for people with coronary heart disease | ||||||
| Patient or population: people with coronary heart disease Setting: hospital/home Intervention: combined interventions Comparison: usual care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual care | Risk with combined interventions | |||||
| Proportion of participants returning to work in the short term (up to 6 months) Follow‐up: range 2.3 months to 4 months | Study population | RR 1.56 (1.23 to 1.98) | 395 (4 RCTs) | ⊕⊕⊝⊝ Low1,2 | Combined rehabilitation interventions may increase the proportion returning to work in the short term (up to 6 months) | |
| 39 per 100 | 61 per 100 (48 to 78) | |||||
| Proportion of participants returning to work in the medium term (6 months ‐ 1 year) Follow‐up: range 6 months to 1 year | Study population | RR 1.06 (1.00 to 1.13) | 992 (10 RCTs) | ⊕⊕⊝⊝ Low3 | Combined interventions may result in little to no difference in the proportion returning to work in the medium term (6 months ‐ 1 year) | |
| 72 per 100 | 76 per 100 (72 to 81) | |||||
| Proportion of participants at work in the long term (> 1 to < 5 years) Follow‐up: range 1.2 years to 3 years | Study population | RR 1.14 (0.96 to 1.37) | 491 (6 RCTs) | ⊕⊝⊝⊝ Very low1,3 | We do not know if combined interventions increase the proportion working long term (> 1 to < 5 years) | |
| 53 per 100 | 60 per 100 (51 to 72) | |||||
| Proportion of participants at work in the extended long term (≥ 5 years) Follow‐up: 5 years | Study population | RR 1.09 (0.86 to 1.38) | 350 (4 RCTs) | ⊕⊝⊝⊝ Very low1,3 | We do not know if combined interventions increase the proportion working after an extended term (≥ 5 years) | |
| 37 per 100 | 41 per 100 (32 to 51) | |||||
| Days until return to work | The mean time to return to work in the intervention group was 40.77 days lower (67.19 lower to 14.35 lower) | ‐ | 181 (2 RCTs) | ⊕⊕⊕⊝ Moderate4 | Combined rehabilitation interventions probably reduce mean time to return to work (days) | |
| Health‐related quality of life assessed with: Angina Pectoris Quality of Life Questionnaire | ‐ | The MD for HrQoL was 0.40 (‐0.03 lower to 0.83 higher) | 87 (1 RCT) | ⊕⊕⊝⊝ Low2,5 | Combined interventions may result in little to no difference in HrQoL | |
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Adverse effects: reinfarctions Follow‐up: mean 3.8 years |
10 per 100 | 6 per 100 (2 to 15) | RR 0.56 (0.23 to 1.43) | 265 (3 RCTs) | ⊕⊕⊕⊝ Moderate1 | Combined interventions likely result in little to no difference in adverse effects |
| *The risk in the Intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HRQoL: health‐related quality of life; RCT: randomised controlled trial; RR: risk ratio; MD: mean difference | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
1Downgraded one level due to imprecision (pooled confidence interval is wide and includes either a possible appreciable harm or benefit). 2Downgraded one level due to risk of bias. 3Downgraded two levels due to risk of bias. 4We detected substantial heterogeneity that we could not completely explain. 5Downgraded one level because only one study reported the effects of the intervention on health‐related quality of life.