Social support for patients with coronary artery disease after percutaneous coronary intervention

The rise and fall of a social support intervention feasibility trial targeting loneliness in patients with cardiac disease - lessons learned and future perspectives

BACKGROUND

One of the psychosocial factors recognized for its positive impact on health outcomes among patients with heart disease, is social support provided by network members. However, an increasing number of patients report to experience loneliness. This study addresses the gap in research on the feasibility of an individually structured social support intervention targeting patients treated for cardiac disease who experience loneliness.

METHOD

A feasibility trial of a 6-month social support intervention targeted patients treated for cardiac disease who experienced loneliness. The intervention involved providing the patient with an informal caregiver, either a person from the patient's social network or a peer, in the long-term rehabilitation phase. Furthermore, the intervention included nurse consultations and motivational text messages. Feasibility was assessed in terms of acceptability and adherence.

RESULTS

During October 2022-July 2023, n = 464 patients were screened for loneliness and 28 (6.0%) screened positive of which 17 (60.7%) accepted to be contacted and receive additional information about the social support intervention. Of these, 2 (11.8%) accepted participation. The low recruitment rate did not meet the predetermined acceptability criterion of 25%.

CONCLUSION

This individually structured social support intervention targeting patients treated for cardiac disease who experience loneliness was non-feasible. The study highlights the complexities of engaging lonely patients in a social support intervention program and contributes with valuable insights for future research aiming to develop effective social support interventions tailored to the needs of cardiac patients who experience loneliness.

TRIAL REGISTRATION

The trial is registered on clinicaltrials.gov (NCT05503810) 18.08.2022.

Perceived social support among percutaneous coronary intervention patients over a long-term follow-up period

AIM

To investigate perceived social support and the associated factors as well as the sources of social support among post-percutaneous intervention patients over a long-term follow-up period.

DESIGN

An explanatory and descriptive survey with a six-year follow-up (STROBE Statement: Supplementary file 1).

METHODS

Baseline data (n = 416) were collected from Finnish patients in 2013, with follow-up data collected from the same study group in 2019 (n = 154). The research employed the Social Support of Patients with Coronary Heart Disease self-reported questionnaire. Data were analysed using descriptive statistics and multivariate methods.

RESULTS

In the acute phase, higher informational support was associated with lower LDL cholesterol and female gender and higher emotional support with working status. In long-term follow-up period, physical activity, younger age, normal cholesterol levels and previous percutaneous coronary intervention predicted higher informational support, regular participation in follow-up sessions and relationship status predicted higher emotional support, and previous coronary artery bypass grafting, smoking, alcohol consumption, normal cholesterol and regular follow-ups predicted higher functional support.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

In their own words: recovery after emergency general surgery in the older patient

Objectives

Emergency general surgery (EGS) conditions, such as perforated intestines or complicated hernias, can lead to significant postoperative morbidity and mortality. We sought to understand the recovery experience of older patients at least 1 year after EGS to identify key factors for a successful long-term recovery.

Methods

We conducted semi-structured interviews to explore recovery experiences of patients and their caregivers after admission for an EGS procedure. We screened patients who were aged 65 years or older at the time of an EGS operation, admitted at least 7 days, and still alive and able to consent at least 1 year postoperatively. We interviewed the patients, their primary caregiver, or both. Interview guides were developed to explore medical decision making, patient goals and expectations surrounding recovery after EGS, and to identify barriers and facilitators of recovery. Interviews were recorded and transcribed, and we used an inductive thematic approach to analysis.

Results

We performed 15 interviews (11 patients and 4 caregivers). Patients wanted to return to their prior quality of life, or 'get back to normal.' Family was key in providing both instrumental support (eg, for daily tasks such as cooking, driving, wound care) and emotional support. Provision of temporary support was key to the recovery of many patients. Although most patients returned to their prior lifestyle, some also experienced depression, persistent abdominal effects, pain, or decreased stamina. When asked about medical decision making, patients expressed viewing the decision for having an operation not as a choice but, rather, the only rational option to treat a severe symptom or life-threating illness.

Conclusions

There is an opportunity in healthcare to provide better education for older patients and their caregivers around instrumental and emotional support to bolster successful recovery after emergency surgery.

Level of evidence

Qualitative study, level II.

The Influence of Personality Type D on Cardiovascular Prognosis in Patients After Coronary Artery Bypass Grafting: Data from a 5-Year-Follow-up Study

BACKGROUND

Type D personality is accompanied by a set of negative behavioral patterns: low physical activity, high levels of psychological distress, low adherence to treatment. However, studies regarding predictive value of the type D personality remain inconclusive: the results varied depending on the examined cohort, age, and ethnicity. The aim of the study was to evaluate the influence of type D personality on the 5-year prognosis in patients undergoing coronary artery bypass grafting (CABG) in Russian population.

METHODS

The study included 602 patients with stable coronary artery disease (490 males, 57.7 ± 7.3 years) who had received CABG and were divided into two groups: patients with type D personality (n = 134) and patients without type D (n = 468). The risk of fatal and nonfatal events within 5 years after CABG was assessed.

RESULTS

There was no difference in total mortality in patients with type D and without type D (7.9% and 7.7%, respectively) over the 5-year period. The absence of cardiac events was detected much less frequently in patients with type D (28%) compared with patients without type D (82%; p = 0.021). Multivariate analysis found independent association between the unfavorable outcome and presence of diabetes mellitus (p = 0.021), type D personality (p = 0.039), and multifocal atherosclerosis (p = 0.033) regardless of gender, age, previous myocardial infarction, and stroke.

CONCLUSIONS

Type D patients had a greater risk for cardiac events over 5 years after CABG compared with non-type D patients. Obtained data indicates that it is reasonable to consider personality type while detecting patients at risk of development of stress induced cardiac complications after CABG.

The effect of sociodemographic factors on anxiety, depression, and perceived social support in patients with internal medicine and surgical problems

PURPOSE

This study aimed to determine the effect of sociodemographic factors on anxiety, depression, and perceived social support in patients with internal medicine and surgical problems.

DESIGN AND METHODS

The study comprised 522 patients who were hospitalized at the internal medicine and surgical clinics of the training and research hospital of a university.

FINDINGS

Of all the patients, 27% were at the risk of anxiety and 51.7% at the risk of depression. Sociodemographic characteristics, health-related issues, and disease characteristics, besides hospitalization-related matters, affected anxiety, depression, and social support levels of patients.

PRACTICE IMPLICATIONS

It was determined that more than half of the patients were at the risk of depression. Perceived social support is essential to reduce the risk of anxiety and depression.