Quality of life comparisons after coronary angioplasty and coronary artery bypass graft surgery

Patient recovery and transitions after hospitalization for acute cardiac events: an integrative review

Despite increased attention to providing seamless transitions after hospitalization, patients often feel unprepared, lack knowledge, and may be confused by what to expect during recovery at home after a cardiac event. Care transition after hospital discharge could be improved by informing and counseling patients more specifically about expected recovery after a cardiac event. Therefore, an integrative review of research was conducted to evaluate cardiac patients' trajectory of recovery after hospitalization. A total of 61 studies were included in this review. Studies included were those of cardiac patients who had been hospitalized for significant cardiac events and those focused on acute coronary syndrome (n = 18), percutaneous coronary intervention (PCI) (n = 12), cardiac surgery (coronary artery bypass surgery and valve surgery; n = 25), and heart failure (n = 6). Studies included quantitative, mixed-methods, and qualitative designs, with sample sizes ranging from 4 to 2121 participants. Notwithstanding the limitations of this review, findings demonstrated that patients' perceptions of their cardiac event evolved over time from uncertainty, fears, anxiety, and depression, which were often associated with a lack of knowledge of their cardiac condition, to a phase of self-management of their cardiac condition. Furthermore, patterns of commonly occurring symptoms and changes in functioning abilities during recovery after hospitalization were apparent among the different cardiac groups. These findings may be useful to both patients and clinicians to inform them about the recovery trajectory after a cardiac event to improve preparation for the transition from hospital to home.

Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery

OBJECTIVE

The study objective was to examine the effect of a symptom management (SM) telehealth intervention on physical activity and functioning and to describe the health care use of older adult patients (aged > 65 years) after coronary artery bypass surgery (CABS) by group (SM intervention group and usual care group).

METHODS

A randomized clinical trial design was used. The study was conducted in 4 Midwestern tertiary hospitals. The 6-week SM telehealth intervention was delivered by the Health Buddy (Health Hero Network, Palo Alto, CA). Measures included Modified 7-Day Activity Interview, RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA), physical activity and exercise diary, Medical Outcomes Study Short-Form 36, and subjects' self-report and provider records of health care use. Follow-up times were 3 and 6 weeks and 3 and 6 months after CABS.

RESULTS

Subjects (N = 232) had a mean age of 71.2 (+4.7) years. There were no significant interactions using repeated-measures analyses of covariance. There was a significant group effect for average kilocalories/kilogram/day of estimated energy expenditure as measured by the RT3 accelerometer, with the usual care group having a higher estimated energy expenditure. Both groups had significant improvements over time for role-physical, vitality, and mental functioning. Both groups had similar health care use.

CONCLUSION

Subjects were able to return to preoperative levels of functioning between 3 and 6 months after CABS and to increase their physical activity over reported preoperative levels of activity. Further study of those patients undergoing CABS who could derive the most benefit from the SM intervention is warranted.

Health-related quality of life: The impact of diagnostic angiography

BACKGROUND

Little is known regarding the effects of index angiograms on health-related quality of life related to angiographic outcome, that is, positive or negative for coronary heart disease (CHD).

METHODS

A longitudinal, comparative design was used. Ninety-three patients underwent initial angiography and completed questionnaires (Cardiac-Quality of Life Index, Short Form-36 mental and physical, and Cardiac Attitudes Index) before, 1 week and 1 year after angiography. Data were evaluated with linear regression and analysis of variance.

RESULTS

Fifty-five patients were CHD positive (age 65.3 ± 10.7 years, 49% were female), and 38 patients were CHD negative (age 59.5 ± 12 years, 53% were female). Compared with CHD-positive patients over 1 year, CHD-negative patients reported lower scores on the Cardiac-Quality of Life Index (P < .008), Short Form-36 mental and physical measures (P = .004), and Cardiac Attitudes Index (P = .05).

CONCLUSION

CHD-negative patients experienced lower health-related quality of life and lower perceived control than CHD-positive patients. After an index angiogram, a negative finding may not be sufficient to relieve negative emotions.

Self-Care Behaviour and Factors Associated with Patient Outcomes Following Same-Day Discharge Percutaneous Coronary Intervention

Background: The demand for percutaneous coronary intervention (PCI) exerts constant pressure on health care systems to meet the growing needs of patients. The practice of same-day discharge PCI has emerged as a medically safe option to optimize resource utilization and improve access to care.

Aim: The purpose of this study was to describe elective same-day discharge PCI patients' self-care behaviour in the two to five days following their procedure, and the factors associated with cardiac self-efficacy (CSE) and self-care agency (SCA).

Methods: Using a cross-sectional correlational design, 98 consecutive patients were contacted by telephone, following PCI, and asked about their CSE, SCA, and adherence to discharge recommendations. Associations between selected variables were explored through multiple regression analysis.

Results: The findings revealed a high degree of adherence to discharge recommendations, although participants' appreciation of the long term management of their chronic disease was limited. Factors associated with lower levels of CSE and SCA included the burden of having additional chronic co-morbidities, living alone and lacking social support, and a positive screening for psychosocial distress.

Conclusion: Same-day discharge PCI presents a sustainable option for delivery of care for most patients. Some clients may require additional support to manage the transition between acute intervention and chronic disease management.

Changes in health-related quality of life following percutaneous coronary intervention: A longitudinal study

BACKGROUND

Coronary artery disease (CAD) is a major cause of mortality and morbidity in developed countries. The percutaneous coronary intervention (PCI) is a frequently used treatment for CAD. In order to manage the disease more effectively and to promote the health-related quality of life (HRQoL) of these patients, understanding the current status of HRQoL before and after PCI procedure is essential.

OBJECTIVES

This study was to examine the changes of HRQoL from before PCI to the first 3 months after PCI on Hong Kong Chinese.

DESIGN

A longitudinal, one-group observational design was used.

SETTING

Data collected from cardiac patients admitted into a regional public hospital at Hong Kong Island for PCI.

PARTICIPANTS

Between August 2003 and February 2004, all patients admitted for non-emergency PCI at the study site and met the inclusion criteria were invited to take part in the study. Seventy-eight out of 85 eligible patients agreed to participate. However, 13 patients dropped out during data collection period.

METHODS

HRQoL data using the Medical Outcomes Study 36-Item Short Form 36 (SF-36) and Seattle Angina Questionnaire (SAQ) were collected before PCI, 1 and 3 months after PCI.

RESULTS

Sixty-five patents completed the study. All domains in SF-36 and SAQ improved at 1 month but the improvements did not continue in all domains at 3 months. The HRQoL measured by SF-36 improved significantly over time (p<0.05) for six out of the eight domains. Scores of all domains of SF-36 improved at 3 months when compared with baseline. Moreover, all five domains of SAQ changed significantly over time (p<0.05); however, the score of angina stability at the third month was lower than that at baseline.

CONCLUSIONS

The results of this study quantify the benefits of PCI procedure on HRQoL of patients. Although PCI improved the HRQoL 1 month after PCI, the effect did not last long. Nursing interventions are needed to maintain and further enhance the HRQoL of these patients and the interventions should be introduced immediately post-PCI.

Health outcomes of patients undergoing cardiac surgery: repeated measures using Short Form-36 and 15 Dimensions of Quality of Life questionnaire

OBJECTIVE

The study assessed health-related quality of life (HRQOL) of patients before and after cardiac surgery.

DESIGN

This was a prospective repeated-measures observational study.

SETTING

The study took place in a 650-bed tertiary referral hospital in Sydney, Australia.

METHODS

HRQOL was measured using the Medical Outcomes Study Short Form 36-item health survey (SF-36) and the 15 Dimensions of Quality of Life questionnaire before surgery, at hospital discharge, and 6 months postdischarge.

RESULTS

Participants were representative of the cardiac surgery population. Scores for several concepts deteriorated at hospital discharge when compared with presurgery. There were significant improvements in health status at 6 months postdischarge when compared with previous measures for the majority of SF-36 and 15 Dimensions of Quality of Life questionnaire concepts, although mental health and social functioning demonstrated significant deterioration. SF-36 scores were substantially lower than population norms, but similar to previous studies of patients undergoing cardiac surgery except for mental health.

CONCLUSION

Deterioration in health status at hospital discharge when compared with presurgery status reinforces the need for further patient care and support after discharge. All dimensions improved after 6 months, except mental health. This information can guide patient expectations regarding rehabilitation posthospitalization, and cardiac surgical services should implement and evaluate formal "outreach programs" for these patients.

Impact of a telehealth intervention to augment home health care on functional and recovery outcomes of elderly patients undergoing coronary artery bypass grafting

OBJECTIVE

This pilot study examined the effect of a home communication intervention (HCI) to augment home health care (HHC) on functioning and recovery outcomes of elderly patients undergoing coronary artery bypass graft.

DESIGN

A randomized, experimental two-group (N = 50) repeated-measures design was used. Both HCI and control subjects received HHC, and the HCI group also received the 12-week HCI delivered by a telehealth device, the Health Buddy (Health Hero Network). The Medical Outcome Study Short Form-36 measured physiologic and psychosocial functioning at baseline, 6 weeks, and 3 months after surgery. Follow-up subject interviews ascertained self-report of postoperative problems and health care use.

SAMPLE

Subjects had an average age of 75.3 years and included males (56%) and females (44%).

RESULTS

By using repeated-measures analyses of covariance, covariating for the total number of HHC visits, HCI subjects, compared with the HHC group only, had a significantly higher adjusted mean general health functioning score (F = 8.41 [1, 36], P < .01). There were significant time effects on physical, role-physical, and mental health functioning, indicating that both groups improved over time. The groups reported similar postoperative problems; however, the control group had more emergency department visits than the HCI group.

CONCLUSIONS

Findings demonstrate the potential benefit of using an HCI to further augment outcomes of high-risk patients undergoing coronary artery bypass graft surgery referred to HHC after hospitalization.

Patterns of recovery following percutaneous coronary intervention: a pilot study

Percutaneous coronary intervention (PCI) is the most common type of cardiac revascularization performed. However, there has been limited research examining the recovery of PCI patients after their hospital discharge. This descriptive, longitudinal study examined patterns of recovery (cardiac symptoms experienced, impact of cardiac symptoms on physical functioning and enjoyment of life, postprocedure problems experienced, and functioning) of 37 PCI patients at 2, 4, and 6 weeks following PCI. Fatigue was the most frequent and persistent symptom, and significantly, F(2, 26) = 3.6, p < .05, it impacted physical functioning at 4 weeks following PCI. Both physical and psychosocial functioning improved over time. Coronary restenosis and heart rhythm disturbance were the most common self-reported heart-related problems. Understanding normal variation in recovery patterns can assist clinicians in developing interventions to facilitate optimal outcomes.

Nursing Outcomes

Percutaneous coronary interventional (PCI) procedures are commonly performed in the United States. The process of caring for this patient population has changed dramatically over the last 10 years, with many of the changes being driven by an evolution in the knowledge base underlying nursing practice. The purpose of this article is to provide a summary and critique of nurse-sensitive outcomes related to patients undergoing PCI procedures and to identify gaps in the literature to provide recommendations for future research. Nursing research on indicators related to costs of care, morbidity, symptom management, functional status, patient/family knowledge, patient responses, behavior, and home/occupational function following PCI are discussed in this review.

Health care implications and space allocation of research published in nursing journals

PURPOSE

To examine how research is disseminated through nursing journals and to examine characteristics of published research.

DESIGN

A cross-sectional descriptive survey was conducted with manuscripts from 78 nursing journals that publish research.

METHOD

The final issue for 1999 was examined. Pairs of independent raters content-analyzed all research manuscripts.

DISCUSSION

Research studies comprised 241 (42.9%) of the manuscripts and 51.4% of the journal space. Many empirical studies omitted validity and reliability. Few manuscripts reported the date for completion of data collection, and fewer than one third contained the length of time from acceptance to publication.

CONCLUSIONS

Enhanced instrumentation reporting, shorter time from data collection to publication, and an increase in journal space devoted to research might enable nurses to make more cutting-edge clinical decisions.

Comparison of recovery patterns for patients undergoing coronary artery bypass grafting and minimally invasive direct coronary artery bypass in the early discharge period

The purpose of this pilot study was to compare the postoperative problems, evaluation and response of symptoms, and functional status (physiologic and psychosocial functioning) during the early recovery period (2, 4, and 6 weeks after surgery) in 35 individuals who underwent coronary artery bypass grafting (n=24) or minimally invasive direct coronary artery bypass (n=11). The most frequent postoperative problem reported by the coronary artery bypass grafting group was an incisional infection (either sternal or leg); 26% reported infection at 2 and 4 weeks, and 21% at 6 weeks after surgery. Respiratory problems (pleural effusion, pneumonia) were the second most frequently reported problem, reported by 10% of the subjects at 2 and 4 weeks and by 16% at 6 weeks. Other, less frequent problems were severe nervousness, rhythm problems, and pericarditis. Minimally invasive direct coronary artery bypass patients reported fewer postoperative or cardiac-related problems, as only 5% indicated a problem with heart failure at both 2 and 4 weeks, and 36% reported being very nervous or having emotional problems at 4 weeks. Unlike postoperative problems, there were numerous similarities in postprocedural symptoms between these two groups. Fatigue, shortness of breath, and pain were the major symptoms reported postdischarge by both groups in this study. In addition, sleeping problems were also fairly prevalent in the coronary artery bypass grafting group, which is understandable, considering the fatigue ratings. Physiologic and psychosocial functioning varied minimally between the two procedures. While there were many similarities in the recovery patterns of both groups, the occurrence of postprocedural problems and symptoms of these two patient groups should be considered by clinicians to further tailor patient education.

Effects of enhanced external counterpulsation on Health-Related Quality of Life continue 12 months after treatment: a substudy of the Multicenter Study of Enhanced External Counterpulsation

BACKGROUND

The Multicenter Study of Enhanced External Counterpulsation (MUST-EECP) was the first prospective, randomized, blinded, sham-controlled study of enhanced external counterpulsation (EECP) in the treatment of chronic stable angina. We previously reported that EECP therapy lengthens the time to exercise-induced myocardial ischemia and reduces angina. We now describe the effects of EECP therapy versus a sham-treated control group in terms of patients' functioning, their senses of well-being and other Health-Related Quality Of Life (HQOL) parameters from baseline to end of treatment and from baseline to 12 months after treatment.

OBJECTIVE

To determine whether a 35-hour course of EECP affects the HQOL of patients with symptomatic coronary artery disease, 12 months following treatment.

METHODS

Seventy-one of the 139 patients enrolled in MUST-EECP provided evaluable patient-completed questionnaires at baseline, at the end of treatment, and 12 months post-treatment. The Medical Outcomes Study 36-Item Short-Form Health Survey and the Quality of Life Index-Cardiac Version III were used to assess effects on HQOL.

RESULTS

Both groups had similar HQOL scores at baseline. At end of treatment and at 12-month follow up, patients who had active-CP reported greater improvement than those who had inactive-CP in all nine quality of life scales, including ability to perform activities of daily living, ability to work, bodily pain, confidence in health, energy, ability to engage in social activities with family and friends, anxiety and depression, and quality of life issues from the effects of angina on health and functioning. Despite small sample sizes, active-CP patients demonstrated significantly greater improvement at 12 months following treatment in bodily pain, social functioning, and quality of life specific to cardiac patients compared with inactive-CP patients.

CONCLUSION

Significant health-related quality of life improvements were measurable up to 12 months after the completion of treatment with EECP. Improvements in this controlled study are consistent with HQOL changes reported in case series and patient registries. Larger studies are warranted.