The Correlation and Mediating Effects Between Self-Efficacy and Quality of Life in Patients with Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Background Cardiovascular diseases (CVDs) are a leading cause of global morbidity, profoundly compromising patients' quality of life (QoL). Self-efficacy (SE)—an individual’s confidence in managing their health—is a modifiable psychosocial factor posited to enhance QoL. However, the aggregated magnitude of this association and the specific pathways through which SE operates remain unclear due to inconsistent primary findings. This study aimed to quantitatively synthesize the correlation between SE and QoL in CVD patients and to qualitatively elucidate the underlying mediating mechanisms.This provides evidence-based guidance for nursing interventions to improve the prognosis of cardiovascular disease (CVD) patients. Methods We conducted a systematic review and meta-analysis to quantitatively synthesize the correlation between SE and QoL in CVD patients and to qualitatively explore potential mediating pathways. We systematically searched Chinese and English databases from inception to September 20, 2025. Two reviewers independently screened studies, extracted data, and assessed quality. Pooled correlation coefficients were calculated using a random-effects model. Subgroup and sensitivity analyses were performed to explore heterogeneity, and mediating pathways were synthesized qualitatively. Results Twenty-six studies were included. Meta-analysis revealed a significant, moderate positive correlation between self-efficacy (SE) and quality of life (QoL) (r = 0.43, 95% CI : 0.38–0.48, p  < 0.001). Subgroup analysis identified SE measure specificity (Q _B = 17.4, p  < 0.001) and study design (Q _B = 9.11, p  = 0.003) as significant moderators. Exercise task-specific SE instruments yielded the strongest correlation (r = 0.52), and cross-sectional studies demonstrated a stronger association (r = 0.45) than longitudinal studies (r = 0.28). The qualitative systematic review delineated multiple mediating pathways: self-management behaviors constituted the most robust and stable core mediator; psychoemotional factors represented complex yet distinct pathways; whereas physiological activity and physical function pathways exhibited greater heterogeneity, with their effects moderated by factors such as disease severity. Conclusions SE is closely associated with QoL in Cardiovascular disease patients, influenced by measurement tools and study design. SE primarily enhances QoL indirectly through self-management behaviors, supplemented by multiple pathways including psychological-emotional regulation and physical activity. Clinical interventions should prioritize self-management and tailor strategies to individual needs.