Effectiveness of coronary heart disease peer support interventions: a systematic review and meta-analysis

To investigate the effect of peer support interventions on psychosocial outcomes, self-management behaviours and readmissions among people with coronary heart disease (CHD). The second aim was to characterise the peer support strategies being tested including the intervention initiation, method, dose, timing, format and content, and the characteristics and training of the peers providing the intervention.

Systematic review and meta-analysis (MEDLINE, Embase, PsycINFO, CINAHL, Scopus, PubMed [non-MEDLINE], Web of Science, and Cochrane Central Register) and risk of bias appraisal was conducted on the above outcomes according to the PRISMA checklist and Cochrane Collaboration guidelines. Meta-analysis was undertaken in RevMan5.4 using the inverse variance method and random effects model. Intervention components and outcomes unsuitable for meta-analysis were narratively synthesised. Sixteen randomised controlled trials (n=2013) were included. Peer support had no effect on anxiety (SMD -0.73, 95%CI -1.57,0.10), depression (SMD -0.09, 95%CI -0.25,0.06), health-related quality of life (SMD -0.38, 95%CI -1.84,1.08), or perceived social support (SMD -0.05, 95%CI -0.31,0.21). However, peer support interventions significantly improved self-management behaviours (SMD 1.49, 95%CI 0.66,2.32) and self-efficacy up to 6 months (SMD 0.57, 95%CI 0.37,0.77), and reduced readmissions (RR 0.25, 95%CI 0.10,0.60). Self-efficacy remained higher in those receiving peer support at 6-12 months post-intervention (SMD 0.67, 95%CI 0.29,1.05). Peer support interventions varied widely, but common strategies included in person (56%), group based (31%) experience sharing (44%). Although subgroup analysis was not possible, narrative synthesis indicated that in-person strategies and peer support that was commenced during admission were the most effective for improving outcomes.

Peer support interventions for people with CHD may be used to improve self-management and self-efficacy, and reduce readmission risk, but anxiety, depression, HRQoL and social support did not reach statistical significance when meta-analysed. In-person, group based and experience sharing were the most common peer support categories, and strategies that were in-person and initiated during admission demonstrated the most consistent improvements across outcomes.

PROSPERO [CRD42024514564].