A systematic review of cardiovascular risk management interventions among community-dwelling people with chronic disease





chronic disease, self-management, risk management, program


Introduction: Cardiovascular diseases (CVD) represent the main cause of mortality in the world. Arterial hypertension, obesity, diabetes, dyslipidemia, sedentary lifestyle and smoking are risk factors for CVD and the main chronic diseases. The evidence on the effectiveness of interventions to promote cardiovascular risk management in chronic disease is still laconic.

Objective: To identify the components of cardiovascular risk management programs for people with chronic illness in the community, as well as the behavioral change techniques used.

Methods: A systematic literature review was carried out in November 2020, following the recommendations of PRISMA. We used the MEDLINE, CINAHL, SCOPUS, Web of Science, Cochrane, Academic Search Complete and Mediclatina databases. The bibliographic sample consisted of 21 articles, involving 26040 people with chronic disease.

Results: The intervention programs are heterogeneous, concerning their components, knowledge disciplines involved, duration and strategies used. The most frequently used behavioral change techniques are advice and negotiation.

Conclusion: We can conclude that educational interventions are a consensual approach to the management of CVD risk in people with chronic diseases. The heterogeneity of the interventions doesn’t allow us to determine the program's effectiveness. Further research is needed to make the results more consistent.


Bullard, T., Ji, M., An, R., Trinh, L., Mackenzie, M., & Mullen, S. P. (2019). A systematic review and meta-analysis of adherence to physical activity interventions among three chronic conditions: cancer, cardiovascular disease, and diabetes. BMC Public Health, 19(1), 636. https://doi.org/10.1186/s12889-019-6877-z

Chodosh, J., Morton, S. C., Mojica, W., Maglione, M., Suttorp, M. J., Hilton, L., Rhodes, S., & Shekelle, P. (2005). Meta-analysis: chronic disease self-management programs for older adults. Annals Of Internal Medicine, 143(6), 427–438. https://doi: 10.7326/0003-4819-143-6-200509200-00007.

Portugal, Direção-Geral da Saúde, Direção de Serviços de Informação e Análise (2016). A saúde dos Portugueses 2016. Lisboa: DGS.

Duff, O. M., Walsh, D. M., Furlong, B. A., O’Connor, N. E., Moran, K. A., & Woods, C. B. (2017). Behavior change techniques in physical activity eHealth interventions for people with cardiovascular disease: systematic review. Journal of Medical Internet Research, 19(8), e281, 1-12. DOI: 10.2196/jmir.7782.

Henriques, H. R. , Pinto, J. , Faria, J., & Silva, A. (2020). Gestão do risco cardiovascular em pessoas com doença crónica na comunidade: uma revisão sistemática da literatura. New Trends in Qualitative Research, 3, 846-857. https://doi.org/10.36367/ntqr.3.2020.846-857

Kastner, M., Cardoso, R., Lai, Y., Treister, V., Hamid, J. S., Hayden, L., ... Holroyd-Leduc, J. (2018). Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis. Cmaj, 190(34), E1004-E1012. https:// doi: 10.1503/cmaj.171391.

Luijks, H., Lucassen, P., Van Weel C., Loeffen, M., Lagro-Jansen, A. & Schermer, T. (2015).How GPs value guidelines applied to patients with multimorbidity: a qualitative study. BMJ Open, 5(10), e007905. https://doi: 10.1136/bmjopen-2015-007905

Meader, N., King, K., Llewellyn, A., Norman, G., Brown, J., Rodgers, M., ... Stewart, G. (2014). A checklist designed to aid consistency and reproducibility of GRADE assessments: development and pilot validation. Systematic reviews, 3(1), 82. https:// doi: 10.1186/2046-4053-3-82

Michie, S., Atkins, L., & West, R. (2014). The behavior change wheel: A guide to designing interventions (1st ed.). London: Silverback Publishing.

Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., ... Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of behavioral medicine, 46(1), 81-95. https:// doi: 10.1007/s12160-013-9486-6

Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., ... Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), 1-9. https://doi.org/10.1186/2046-4053-4-1

Mudaliar, U., Zabetian, A., Goodman, M., Echouffo-Tcheugui, J. B., Albright, A. L., Gregg, E. W., & Ali, M. K. (2016). Cardiometabolic risk factor changes observed in diabetes prevention programs in US settings: A systematic review and meta-analysis. Plos Medicine, 13(7), e1002095. https://doi.org/10.1371/journal.pmed.1002095

Pengpid, S., Peltzer, K., Puckpinyo, A., & Chantarasongsuk, I. J. (2019). Effectiveness of a cluster-randomized controlled trial community-based lifestyle intervention program to control prehypertension and/or prediabetes in Thailand. International Journal of Diabetes in Developing Countries, 39(1), 123-131. https://doi.org/10.1007/s13410-018-0641-2

Peters, R., Ee, N., Peters, J., Beckett, N., Booth, A., Rockwood, K., & Anstey, K. J. (2019). Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction. Therapeutic advances in chronic disease, 10, 2040622319880392. https://doi: 10.1177/2040622319880392

Reynolds, R., Dennis, S., Hasan, I., Slewa, J., Chen, W., Tian, D., ... Zwar, N. (2018). A systematic review of chronic disease management interventions in primary care. BMC family practice, 19(1), 11. https://doi: 10.1186/s12875-017-0692-3

Sawyer, A., Lewthwaite, H., Gucciardi, D. F., Hill, K., Jenkins, S., & Cavalheri, V. (2019). Behaviour change techniques to optimise participation in physical activity or exercise in adolescents and young adults with chronic cardiorespiratory conditions: a systematic review. Internal Medicine Journal, 49(10), 1209–1220. https://doi.org/10.1111/imj.14141

Uthman, O. A., Hartley, L., Rees, K., Taylor, F., Ebrahim, S., & Clarke, A. (2015). Multiple risk factor interventions for primary prevention of cardiovascular disease in low‐and middle‐income countries. Cochrane Database of Systematic Reviews, 8, CD011163. https:// doi: 10.1002/14651858.CD011163.pub2

Van der Heide, I., Snoeijs, S., Quattrini, S., Struckmann, V., Hujala, A., Schellevis, F., & Rijken, M. (2018). Patient-centeredness of integrated care programs for people with multimorbidity. Results from the European ICARE4EU project. Health Policy, 122(1), 36-43. https://doi: 10.1016/j.healthpol.2017.10.005

Wade, V., & Stocks, N. (2017). The use of telehealth to reduce inequalities in cardiovascular outcomes in Australia and New Zealand: A critical review. Heart, Lung & Circulation, 26(4), 331–337. https://doi.org/10.1016/j.hlc.2016.10.013

Wagner, E. H., Austin, B. T., Davis, C., Hindmarsh, M., Schaefer, J., & Bonomi, A. (2001). Improving chronic illness care: translating evidence into action. Health affairs, 20(6), 64-78. https:// doi: 10.1377/hlthaff.20.6.64

World Health Organization (2017, may 17). Cardiovascular diseases (CVDs). Retrieved from https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

World Health Organization. (2018). Noncommunicable diseases country profiles 2018. Geneva, WHO. Retrieved from https://www.who.int/nmh/publications/ncd-profiles-2018/en/

Xu, X., Mishra, G. D., & Jones, M. (2017). Evidence on multimorbidity from definition to intervention: an overview of systematic reviews. Ageing research reviews, 37, 53-68. https://doi: 10.1016/j.arr.2017.05.003

Yeoh, E. K., Wong, M. C. S., Wong, E. L. Y., Yam, C., Poon, C. M., Chung, R. Y., ... Coats, A. J. S. (2018). Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review. International Journal Of Cardiology, 258, 279–288. https://doi.org/10.1016/j.ijcard.2017.11.057





Life and Healthcare Sciences