The lack of evidence for the effectiveness of discharge education on clinical outcomes in acute coronary syndrome patients: a systematic review. where to from here?

Background/Introduction: It is well established that acute coronary syndrome remains a leading cause of morbidity and mortality worldwide. Targeted-patient discharge education in combination with cardiac rehabilitation and secondary prevention programs positively impact upon recovery and clinical outcomes. Whilst, there is strong evidence supporting the content of discharge instructions (i.e. CVD prevention strategies, components and modes of delivery) it is unknown how discharge education provided during the acute hospitalisation period impacts upon clinical outcomes and which elements of this material contributes to improvements. Purpose: In order to bridge the knowledge gap, this review seeks to synthesize the existing evidence for the efficacy of discharge education provided in the acute hospitalisation period, to adult patients admitted to hospital for acute coronary syndrome, and to objectively report on the behaviour changes measured in this population. Methods: A systematic review was undertaken of RCTs published in English between 2000 and 2017. Searching the following databases: Medline; CINAHL; PsycINFO; Scopus; Web of Science; Cochrane Central Trials Register of Controlled Trials; ANZ Clinical Trials Registry; Clinicaltrials.gov; and WHO International Clinical Trial Registry Platform. Studies assessing the following outcomes were considered for inclusion: ACS prevention, diagnosis and treatment, patient knowledge of clinical and lifestyle risk factors. Uptake of treatment recommendations, medication adherence, GP follow-up and attendance at a formal cardiac rehabilitation program, all cause- and ACS-related hospital re-admission and mortality (up to 12 months). Studies with post-discharge follow-up reinforcing intervention content were excluded. Articles identified for inclusion were screened for additional studies. The risk of bias was assessed using the Joanna Briggs Institute standardized critical appraisal instrument for RCTs. Results: From 2,093 citations, 47 papers were selected for assessment of eligibility with one pilot study (n=40) found to evaluate the effectiveness of discharge education on participation in cardiac rehabilitation. The results from this study showed increased participation in cardiac rehabilitation following two highly individualised information sessions. Conclusion: The findings from this review show that there is limited evidence for the effectiveness of discharge education provided to acute coronary syndrome patients at the bedside. Highlighting the need for robust evidence for the comprehensive evaluation of current discharge patient education.