Document Type : Original Article


1 Master of Critical Care Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

2 Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran

3 Emergency Department, Paramedical Faculty, Qom University of Medical Sciences, Qom, Iran

4 Master of Critical Care Nursing, Shahid Beheshti-Amir Al-Momenin Department, Qom University of Medical Sciences, Qom, Iran

5 Emergency Department, Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran


BACKGROUND: Coronary artery disease (CAD) is a life‑threatening condition that causes physical
and psychological disorders and decreases patients’ quality of life (QoL). Performing proper
educational self‑care program may lead to higher QoL in these patients. This study was performed
to investigate the effectiveness of a self‑care educational program on QoL in patients with CAD.
MATERIALS AND METHODS: This semi‑experimental study was performed on 60 patients with
CAD referred to the cardiac rehabilitation (CR) center of Vali Asr hospital in Qom, Iran, in 2018–2019.
Patients were divided into control and intervention groups by randomized sampling. The self‑care
educational program was provided through lectures and booklet. Data collection was done using the
“demographic and clinical data questionnaire,” and “Seattle Angina questionnaire.” Questionnaires
were completed in both groups, before and at least 1 month after education. Analysis of the obtained
data was performed using SPSS software (version 25), central indexes, Mann–Whitney test, and
Wilcoxon test.
RESULTS: No significant differences were observed between the two groups for demographics
characteristics and quality of life before the intervention. Before the self‑care program, the mean score
of the QoL in the intervention and control group were 56.14 ± 9.75 and 58.46 ± 11.71, respectively.
After that, the mean score of the QoL in the intervention and control group were 59.25 ± 10.56 and
59.7 ± 13.33, respectively. The statistical analysis showed significant differences in the mean scores
of QoL in the intervention group before and after the intervention (P < 0.05). However, no statistically
significant differences were seen in the control group before and after the study (P > 0.05).
CONCLUSIONS: The self‑care educational program improved the QoL in patients with CAD.
Therefore, lectures and educational booklets should be considered by CR nurses.


1. AnandSS, Yusuf S. Stemming the global tsunami of cardiovascular
disease. Lancet 2011;377:529‑32.
2. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R,
et al. Heart disease and stroke statistics‑2017 update: A report from
the American Heart Association. Circulation 2017;135:e146‑603.
3. Gaziano TA, Bitton A, Anand S, Abrahams‑Gessel S, Murphy A.
Growing epidemic of coronary heart disease in low‑ and
middle‑income countries. Curr Probl Cardiol 2010;35:72‑115.
4. Mohammad AM, Jehangeer HI, Shaikhow SK. Prevalence and
risk factors of premature coronary artery disease in patients
undergoing coronary angiography in Kurdistan, Iraq. BMC
Cardiovasc Disord 2015;15:155.
5. Sanchis‑Gomar F, Perez‑Quilis C, Leischik R, Lucia A.
Epidemiology of coronary heart disease and acute coronary
syndrome. Ann Transl Med 2016;4:256.
6. Sarrafzadegan N, Mohammmadifard N. Cardiovascular disease
in Iran in the last 40 years: Prevalence, mortality, morbidity,
challenges and strategies for cardiovascular prevention. Arch
Iran Med 2019;22:204‑10.
7. Joseph P, Leong D, McKee M, Anand SS, Schwalm JD, Teo K, et al.
Reducing the global burden of cardiovascular disease, Part 1: The
epidemiology and risk factors. Circ Res 2017;121:677‑94.
8. Maleki M, Alizadehasl A, Haghjoo M. ST‑segment elevation
myocardial infarction. In: Practical Cardiology. Ch. 19.
Philadelphia, PA: Elsevier; 2017. p. 311‑28.
9. Hong E. Health‑related quality of life and health condition
of community‑dwelling populations with cancer, stroke, and
cardiovascular disease. J Phys Ther Sci 2015;27:2521‑4.
10. Campbell DJ. Primary prevention of cardiovascular disease: New
guidelines, technologies and therapies. Med J Aust 2014;200:146.
11. Ludt S, Wensing M, Szecsenyi J, van Lieshout J, Rochon J,
Freund T, et al. Predictors of health‑related quality of life in
patients at risk for cardiovascular disease in European primary
care. PLoS One 2011;6:e29334.
12. Organization WH. Measuring Quality of Life: The World Health
Organization Quality of Life Instruments (the WHOQOL‑100
and the WHOQOL‑BREF). WHOQOL‑Measuring
Quality of Life; 1997.
13. Ebrahimi M, Kazemi‑Bajestani SM, Ghayour‑Mobarhan M,
Ferns GA. Coronary artery disease and its risk factors status in
Iran: A review. Iran Red Crescent Med J 2011;13:610‑23.
14. Maleki A, Ghanavati R, Montazeri M, Forughi S, Nabatchi B.
Prevalence of coronary artery disease and the associated risk
factors in the adult population of Borujerd City, Iran. J Tehran
Heart Cent 2019;14:1‑5.
15. Cho E, Sloane DM, Kim EY, Kim S, Choi M, Yoo IY, et al. Effects
of nurse staffing, work environments, and education on patient
mortality: An observational study. Int J Nurs Stud 2015;52:535‑42.
16. Shahsavari H, Matory P, Zare Z, Taleghani F, Kaji MA. Effect of
self‑care education on the quality of life in patients with breast
cancer. J Educ Health Promot 2015;4:70.
17. Salem P, SandlerI, Wolchik S. Taking stock of parent education in
the family courts: Envisioning a public health model. Fam Court
Rev 2013;51:131‑48.
18. Evangelista LS, Shinnick MA. What do we know about adherence
and self‑care? J Cardiovasc Nurs 2008;23:250‑7.
19. Lee CS, Moser DK, Lennie TA, Riegel B. Event‑free survival in
adults with heart failure who engage in self‑care management.
Heart Lung 2011;40:12‑20.
20. OrganizationWH. Health Education in Self‑Care: Possibilities and
Limitations. World Health Organization; 1984.
21. Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB,
Lee CS, et al. Self‑care for the prevention and management of
cardiovascular disease and stroke: A scientific statement for
healthcare professionals from the American Heart Association.
J Am Heart Assoc 2017;6:e006997.
22. Jaarsma T, Strömberg A, Ben Gal T, Cameron J, Driscoll A,
Duengen HD, et al. Comparison of self‑care behaviors of heart
failure patients in 15 countries worldwide. Patient Educ Couns
23. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M,
et al. European Guidelines on cardiovascular disease prevention
in clinical practice (version 2012). The Fifth Joint Task Force
of the European Society of Cardiology and Other Societies on
Cardiovascular Disease Prevention in Clinical Practice (constituted
by representatives of nine societies and by invited experts). Eur
Heart J 2012;33:1635‑701.
24. Bush M, Kucharska‑Newton A, Simpson RJ Jr., Fang G,
Stürmer T, Brookhart MA. Effect of initiating cardiac rehabilitation
after myocardial infarction on subsequent hospitalization in older
adults. J Cardiopulm Rehabil Prev 2020;40:87‑93.
25. Francis T, Kabboul N, Rac V, Mitsakakis N, Pechlivanoglou P,
BieleckiJ, et al. The effect of cardiac rehabilitation on health‑related
quality of life in patients with coronary artery disease:
A meta‑analysis. Can J Cardiol 2019;35:352‑64.
26. Lavie CJ, Menezes AR, De Schutter A, Milani RV, Blumenthal JA.
Impact of cardiac rehabilitation and exercise training on
psychological risk factors and subsequent prognosis in patients
with cardiovascular disease. Can J Cardiol 2016;32:S365‑73.
27. Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K,
Martin N, et al. Exercise‑based cardiac rehabilitation for coronary
heart disease: Cochrane systematic review and meta‑analysis.
J Am Coll Cardiol 2016;67:1‑12.
28. Taheri‑Kharameh Z, Heravi‑Karimooi M, Rejeh N, Hajizadeh E,
Vaismoradi M, Snelgrove S, et al. Translation and psychometric
testing of the Farsi version of the Seattle angina questionnaire.
Health Qual Life Outcomes 2017;15:234.
29. Nekouei ZK, Yousefy A, Manshaee G. Cognitive‑behavioral
therapy and quality of life: An experience among cardiac patients.
J Educ Health Promot 2012;1:2.
30. Vahedian‑Azimi A, Alhani F, Goharimogaddam K, Madani S,
NaderiA, HajiesmaeiliM. Effect of family‑centered empowerment
model on the quality of life in patients with myocardial infarction:
A clinical trial study. J Nurs Educ 2015;4:8‑22.
31. Ebrahimi H, Abbasi A, Bagheri H, Basirinezhad MH, Shakeri S,
Mohammadpourhodki R. The role of peer support education
model on the quality of life and self‑care behaviors of patients
with myocardial infarction. Patient Educ Couns 2021;104:130‑5.
32. Moattari M, Adib F, Kojuri J, Tabatabaee SH. Angina self‑management plan and quality of life, anxiety and depression
in post coronary angioplasty patients. Iran Red Crescent Med J
33. Dastgerdi FA, Zandiyeh Z, Kohan S. Comparing the effect
of two health education methods, self‑directed and support
group learning on the quality of life and self‑care in Iranian
postmenopausal woman. J Educ Health Promot 2020;9:62.
34. Ahn S, Song R, Choi SW. Effects of self‑care health behaviors on
quality of life mediated by cardiovascular risk factors among
individuals with coronary artery disease: A structural equation
modeling approach. Asian Nurs Res (Korean Soc Nurs Sci)
35. González‑Chica DA, Mnisi Z, Avery J, Duszynski K, Doust J,
Tideman P, et al. Effect of health literacy on quality of life amongst
patients with Ischaemic Heart Disease in Australian General
Practice. PLoS One 2016;11:e0151079.
36. Lima MA, Duque AP, Rodrigues Junior LF, Lima VC, Trotte LA,
Guimaraes TC. Health literacy and quality of life in hospitalized
heart failure patients: A cross‑sectional study. Am J Cardiovasc
Dis 2020;10:490‑8.
37. Dickson VV, Chyun D, Caridi C, Gregory JK, Katz S. Low literacy
self‑care management patient education for a multi‑lingual
heart failure population: Results of a pilot study. Appl Nurs Res
38. Asadi P, Ahmadi S, Abdi A, Shareef OH, Mohamadyari T, Miri J.
Relationship between self‑care behaviors and quality of life in
patients with heart failure. Heliyon 2019;5:e02493.
39. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Self‑measured
blood pressure monitoring in the management of hypertension:
A systematic review and meta‑analysis. Ann Intern Med
40. Berndt N, Bolman C, Froelicher ES, Mudde A, Candel M,
de Vries H, et al. Effectiveness of a telephone delivered and
a face‑to‑face delivered counseling intervention for smoking
cessation in patients with coronary heart disease: A 6‑month
follow‑up. J Behav Med 2014;37:709‑24.
41. Strömberg A, Dahlström U, Fridlund B. Computer‑based
education for patients with chronic heart failure. A randomised,
controlled, multicentre trial of the effects on knowledge,
compliance and quality of life. Patient Educ Couns 2006;64:128‑35.
42. Rahmani A, Vahedian‑Azimi A, Sirati‑Nir M, Norouzadeh R,
Rozdar H, Sahebkar A. The effect of the teach‑back method on
knowledge, performance, readmission, and quality of life in heart
failure patients. Cardiol Res Pract 2020;2020: 8897881.