According to the “5S” evidence resource model (12), evidence retrieval is searched from the top-down. The databases searched included: BMJ Best Practice, Up To Date, National Institute of Health and Clinical Excellence (NICE), National Guideline Clearinghouse (NGC), Guideline International Network (GIN), Scottish Intercollegiate Guidelines Network (SIGN), European Society of Cardiology (ESC), American Heart Association (AHA), Cochrane Library,Web of Science, PubMed, Australian JBI Proof-Based Health Care Database, China Biology Medicine, China Knowledge Resource Integrated Database (CNKI), Wanfang and VIP. Corresponding search terms included combinations of: “Coronary Disease/coronary heart disease/Percutaneous Coronary Intervention/percutaneous coronary interventions” “stress/psychological/psychological stress/psychological status/negative emotions/fear/anxiety/depression” “guideline/systematic review/meta-analysis/evidence summary/consensus/clinical decision/best practice”. The search encompassed records from database inception to 10 September 2025.

Inclusion criteria were as follows: (a) the study population consisted of patients with CHD, (b) the study content involved nursing care related to adverse psychological stress responses in these patients, (c) outcome measures included psychological stress, (d) evidence types included expert consensus, systematic reviews, guidelines, evidence summaries, and meta-analyses, (e) language was either Chinese or English.

Exclusion criteria were as follows: (a) literature with incomplete content or for which the full text could not be obtained, (b) literature type was conference abstract, guideline interpretation, research plan/proposal or the old guide that has been replaced.

The design and implementation of this study followed the PRISMA guidelines. Literature screening was conducted independently by two researchers. Duplicates were merged and removed using EndNote X9, and title/abstract screening as well as full-text screening were assisted by the software. Any inconsistencies were resolved by discussion or arbitration by a third researcher.

The included literature underwent a structured quality assessment. Clinical guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument (13). Systematic reviews, expert consensuses, and evidence summaries were evaluated using the corresponding critical appraisal tools from the Australian JBI Centre for Evidence-Based Health Care (2016) (14). Following independent assessments, the two researchers compared their results, and any discrepancies were resolved through discussion or by consulting a third researcher to reach consensus.

The included evidence was appraised using the JBI Evidence Grading and Recommendation System, with evidence levels graded from 1 to 5 (15). Under the guidance of the FAME structure, a comprehensive evaluation was conducted, and the recommendation strength was categorized as either Grade A (strong recommendation) or Grade B (weak recommendation).

This study initially retrieved 1,845 publications. After reviewing titles, abstracts, and full texts, duplicate and non-conforming literature were excluded. A total of 21 articles were ultimately included, comprising 3 guidelines (16–18), 5 expert consensuses (19–23), 1 clinical decision (24), and 12 systematic reviews (9, 25–35). The study selection process is presented in Supplementary Figure 1, and the basic characteristics of the included literature are presented in Table 1.

Through the synthesis of evidence related to psychological stress assessment and intervention in patients with CHD, 24 evidence-based recommendations were ultimately formulated across five domains: personnel qualifications and team composition, psychological assessment, psychological intervention, continuity of care and follow-up management, and identification and referral of severe issues. Details are presented in Table 4.

Multidisciplinary team is the key way to improve the psychological nursing system for patients with CHD. The ideal team should include professionals in the fields of cardiology, nursing, cardiac rehabilitation and psychiatry (24). As first-line managers, nurses play an important role in early identification of patients with post-traumatic stress disorder, anxiety, depression and other negative emotions. However, at present, nurses generally lack systematic psychological assessment and intervention training, and their core competence is limited (36–38). At the same time, it should be noted that non-professionals must obtain corresponding qualifications for psychological intervention, which constitutes an institutional barrier to ability transformation (39). Therefore, it is necessary to establish a hierarchical psychological nursing training system for cardiovascular nurses. Through the combination of short-term special training and long-term systematic education, it is necessary to focus on improving their core competencies such as psychological assessment, basic intervention and therapeutic communication, and to support nurses to obtain psychological related qualifications through institutionalized incentives to ensure the effectiveness of nursing practice norms.

CHD as a major negative health event, tends to exert a persistent psychological impact on patients and trigger intense stress responses (40). Research indicates that patients with coronary heart disease exhibit a higher incidence of psychosocial distress during the perioperative period, and associated negative emotions may persist into the post-discharge phase (41, 50). However, current research primarily focuses on the diagnosis and treatment of acute-phase CHD, with insufficient attention paid to patients’ mental health during the post-discharge rehabilitation phase (11, 42). This results in inadequate intervention for adverse health outcomes caused by psychological distress. Therefore, this study recommends integrating psychological assessment into the routine management process for CHD. Specifically, initial screening should be initiated at an early stage to promptly identify adverse psychological stress. Building on this, a dynamic assessment process spanning the entire disease course should be established, enabling targeted interventions based on the psychological characteristics of patients at each stage, ultimately aiming to alleviate psychological distress and enhance participation and adherence to cardiac rehabilitation.

In the process of implementing dynamic assessment, in addition to paying attention to the immediate psychological state of patients, stable individual factors should also be integrated. Studies have shown that personality traits (Neuroticism and Conscientiousness) are systematically associated with patients ‘ self-health evaluation, psychological distress and disease management response (43, 44). For example, individuals with high Neuroticism may require earlier emotional regulation support, while those with low Conscientiousness may rely on more structured behavioral supervision and follow-up. Recent studies have further revealed that among patients with CHD, individuals with lower levels of Conscientiousness may be more vulnerable when facing long-term rehabilitation management and lifestyle adjustments, with corresponding increases in psychological risk (42). At present, the relevant evidence on CHD and personality traits mainly focuses on cross-sectional studies, but these findings provide an important theoretical basis for the construction of a precise nursing model of personality adaptability ‘ in the future (43). Future research can further verify whether the inclusion of personality traits in dynamic assessment can effectively identify high-risk groups, and explore the feasibility and effectiveness of providing enhanced emotional regulation training or more structured behavioral supervision.

The rational application of psychological care techniques serves as an effective means to alleviate psychosocial distress in patients with CHD (45). Intervention formats should be flexibly selected and combined based on the patient's disease stage, psychological needs, and resource availability, such as individual counseling, group support, and remote guidance. This approach enhances the accessibility and adaptability of psychological support (25).

In terms of intervention content, psychological nursing should form a hierarchical content system of “basic support-structured intervention-continuous reinforcement”. Basic support technologies such as listening, empathy and affirmation are the cornerstones for establishing treatment alliances and promoting communication and trust (33, 46). On this basis, structured intervention methods with empirical support can be introduced for specific problems of patients. Among them, cognitive behavioral therapy is recommended as a first-line psychological intervention program for CHD patients with depression or anxiety through cognitive reconstruction and behavioral activation, which can help alleviate emotional symptoms and improve self-management ability (47). Mindfulness training, stress management, and Internet-based individualized interventions have also shown positive effects in improving emotional regulation and treatment compliance (28, 31, 33, 48). Looking forward to the future, while systematically implementing evidence-based programs, we can actively explore the innovative integration of localized physical and mental adjustment techniques such as traditional Chinese medicine emotional conditioning and modern psychological nursing models, and it is expected to develop an integrated intervention path that is more in line with China ’s cultural context and patients ‘ health beliefs.

Establishing a systematic continuity of care framework is essential for ensuring the continuity and comprehensiveness of psychological support for patients (49). During discharge preparation, accessible psychological support resources should be systematically organized for patients and families (20). Standardized follow-up records should be established to support ongoing dynamic monitoring and intervention. In the post-discharge follow-up phase, diversified follow-up support channels need to be developed (17, 33). Nurses should collaborate with patients and their families at discharge to develop individualized follow-up plans. These plans may use outpatient visits, telephone calls, video consultations, and mobile apps to continuously monitor psychological status and changes, improving the timeliness and precision of interventions.

When screening reveals complex or severe psychological problems, promptly activate a cross-disciplinary collaboration (24, 32). Include psychiatrists and specialist nurses in joint consultations to formulate intervention plans. Establish clear referral pathways for patients with moderate to severe disorders to psychiatry for systematic evaluation and treatment. This supports the complete management cycle of screening, identification, referral, and intervention.