Coronary atherosclerotic heart disease is a disease of coronary artery atherosclerosis causing blockage or narrowing of the vessel wall,1 referred to as coronary heart disease (CHD). CHD has attracted much attention because of its high morbidity and mortality and has been called the "number one killer" of human health.2 CHD is a lifelong, chronic, and progressive cardiovascular disease that affects approximately 523 million people globally and 11 million people in China.3 Older adults are especially at high risk of CHD, as age is a significant predictor of CHD-related mortality.4 The prevalence of CHD in people aged 60 and above is up to 28 %, with the prevalence and mortality rates still on the rise.3 It is thus critical to identify risk factors of CHD to guide early prevention and timely intervention of CHD.

Unhealthy lifestyle behaviors (e.g., physical inactivity, smoking, excessive alcohol consumption, and inadequate intake of fruits) are well-established risk factors for CHD development.5 Effective prevention of CHD largely relies on self-management/care in the community.3 Self-management is a decision-making process to regulate an individual's knowledge, attitudes, and self-efficacy to promote healthy behaviors (e.g., unhealthy lifestyle changes) to achieve beneficial health outcomes (e.g., prevention of CHD).6 While many risk factors of CHD are associated with poor self-management, good self-management can prevent the development of CHD. A recent meta-review of 15 meta-analyses assessing the role of self-management in CHD prevention has shown promising results.7 Specifically, two main components of self-management, self-monitoring and self-regulation, have been shown to improve health behavior changes and outcomes, providing valuable evidence and guidance to inform further CHD prevention.7

Meanwhile, continuous anxiety and depression are also risk factors for CHD, with a recent review showing a causal relationship between anxiety/depression and CHD.8 Epidemiological surveys found that anxiety increased the risk of CHD by 41 %,9 while depression increased the risk of CHD by 30 % compared with people without anxiety or depression.10 Another clinical study showed that about 31 % of patients with CHD had symptoms of anxiety and depression.11 Despite the well-established behavioral and psychological risk factors of CHD, few intervention programs are focusing on behavioral and psychological self-management for CHD prevention. Therefore, there is an urgent need to construct a new health management intervention program to improve the behavioral and psychological self-management ability of older adults with high risk of CHD to prevent the development of CHD.

Solution-focused brief therapy (SFBT) is a clinical intervention model proposed by Steve de Shazer12 and introduced into nursing by McAlliste13 in 2002. SFBT was developed in the context of positive psychology with full respect for the individual and belief in the individual's resources and potential. It consists of five steps: describing the problem, framing the goal, probing for exceptions, giving feedback, and evaluating progress.13 A large body of research has consistently shown the effectiveness of SFBT in improving a wide variety of behavioral and psychological outcomes.14 A recent study showed that SFBT was effective in reducing blood glucose among older adults with Type 2 Diabetes.15 Other studies also showed that SFBT reduced anxiety and depression levels in stroke patients16 and enhanced fluid intake adherence in hemodialysis patients.17 SFBT helps patients gradually find success in negative emotions or events, thus perceiving hope, discovering goals, and promoting their self-growth.18

Although SFBT has been effectively applied to various populations to improve behavioral and psychological health outcomes, fewer studies have focused on older adults at high risk of CHD. Therefore, this study developed a nursing program based on SFBT and tested its effectiveness in improving self-care and alleviating anxiety and depression among older adults at risk of CHD.