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Callus E, Pagliuca S, Bertoldo EG, Fiolo V, Jackson AC, Boveri S, De Vincentiis C, Castelvecchio S, Volpe M, Menicanti L. The Monitoring of Psychosocial Factors During Hospitalization Before and After Cardiac Surgery Until Discharge From Cardiac Rehabilitation: A Research Protocol. Front Psychol 2020; 11:2202. [PMID: 33117210 PMCID: PMC7550819 DOI: 10.3389/fpsyg.2020.02202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/05/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction: There is considerable evidence that psychosocial factors contribute to the etiology and prognosis of cardiac illness. Currently, in Italy, psychologists are only obligatory in the cardiac rehabilitation setting, although there are indications that patients could be experiencing distress also during other moments of hospitalization, such as on admission for cardiac surgery. Objective and Methods: The objective of this protocol is to gain more information about cardiac patients, specifically during the various moments of hospitalization for cardiac surgery, by collecting data at admission before cardiac surgery (t0), at admission to cardiac rehabilitation (t1), and at discharge (t2) at the Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato hospital. A psychosocial questionnaire was constructed after consulting the relevant national and international guidelines. Patients admitted for cardiac surgery and attending a rehabilitation program will be evaluated by acquiring data about their civil status, religiosity, education and work capacity, social condition (including the presence and quality of intimate relationships and support received), previous psychological and psychiatric histories, psychological status, lifestyle (including questions on nutrition, smoking, alcohol, and substance abuse), adherence to therapy, quality of life (QoL), health perception, anxiety, and depression at t0. Health perception, anxiety, and depression are also measured at t1 and t2. Discussion and Conclusion: This study is an attempt to identify the recommended psychosocial variables which need to be monitored during cardiac patients' hospitalization for cardiac surgery, through to the completion of cardiac rehabilitation. After implementing this study at the IRCCS Policlinico San Donato, attempts will be made to create studies on a national and international level to generate more evidence regarding these variables, in order to create tailor-made interventions for these patients during these specific and delicate moments.
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Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Silvana Pagliuca
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Valentina Fiolo
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Carlo De Vincentiis
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Marianna Volpe
- Department of Cardiac Rehabilitation, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Cromhout PF, Moons P, Thygesen LC, Nashef S, Damgaard S, Berg SK. Time to expand risk evaluation systems for cardiac surgery? Looking beyond physiological parameters. Eur J Cardiovasc Nurs 2018; 17:760-766. [DOI: 10.1177/1474515118783835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Risk assessment in cardiac surgery traditionally consists of medical and physiological parameters. However, non-physiological factors have also been found to be predictive of poor outcomes following cardiac surgery. Therefore, the isolated focus on physiological parameters is questionable. This paper describes the emotional, behavioural, social and functional factors that have been established to play a role in outcomes following cardiac surgery. This forms a basis for future research, testing the value of these factors above and beyond the physiological parameters. By including such non-physiological factors, the accuracy of the existing risk scoring systems could potentially be improved.
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Affiliation(s)
- Pernille F Cromhout
- Department of Thoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Sune Damgaard
- Department of Cardio-thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Selina Kikkenborg Berg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
- Department of Public Health, University of Copenhagen, Denmark
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Poitras S, Beaule PE, Dervin GF. Validity of a short-term quality of life questionnaire in patients undergoing joint replacement: the Quality of Recovery-40. J Arthroplasty 2012; 27:1604-1608.e1. [PMID: 22595180 DOI: 10.1016/j.arth.2012.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 03/13/2012] [Indexed: 02/01/2023] Open
Abstract
One hundred thirty-two patients undergoing total hip or knee arthroplasty were evaluated before and after surgery with the Quality of Recovery-40 (QoR-40) and the Short Form 12 (SF-12) questionnaires seven times over a 4-month period, with the objective of comparing their psychometric properties. Physical dimensions of the QoR-40 and SF-12 were not related in the days after surgery but moderately related over the first month. Only the change in score for the physical independence dimension of the QoR-40 exceeded measurement error. Effect sizes were larger for the QoR-40 within the first month post-surgery and larger for the SF-12 past 1 month. Effect sizes were larger for the physical dimensions of both instruments compared to the psychological dimensions. Only the physical independence dimension of the QoR-40 appears useful to assess the quality of life in the first month following surgery.
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Abstract
This review article summarizes the major studies that have investigated the outcomes of coronary artery bypass graft surgery (CABG). The article includes a review of the literature in the areas of: history of CABG; indications for CABG; and measurement of quality of life following CABG, including prolongation of life, physical functioning (ie, relief from angina and dyspnea, physical activity, as well as complications of surgery and re-hospitalization), psychological functioning, and social functioning. Overall, the literature demonstrates that the outcomes of CABG have historically been measured in terms of mortality and morbidity; however, it has now been well recognized that adjustment to CABG is a multidimensional phenomenon that is not fully explained by medical factors. Therefore, in addition to studying mortality and morbidity outcomes following CABG many recent studies have identified that it is important to investigate various physical, psychological, and social variables that have a significant impact on post-operative adjustment to CABG.
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Affiliation(s)
- Anna Louise Hawkes
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia.
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Rothenhäusler HB, Grieser B, Nollert G, Reichart B, Schelling G, Kapfhammer HP. Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study. Gen Hosp Psychiatry 2005; 27:18-28. [PMID: 15694215 DOI: 10.1016/j.genhosppsych.2004.09.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Accepted: 09/08/2004] [Indexed: 11/15/2022]
Abstract
Little is known concerning the natural history of psychiatric morbidity, postoperative delirium, cognitive decline and health-related quality of life (HRQOL) in cardiac surgery patients and the impact of neurocognitive dysfunction on HRQOL after cardiac surgery with cardiopulmonary bypass (CPB). In a prospective study, we followed up for 1 year 30 of the original 34 patients who had undergone cardiac surgery with CPB. Patients were assessed preoperatively, before discharge, and at 1 year after surgery with the Structural Clinical Interview for DSM-IV and a series of neuropsychological tests. Psychometric scales were administered to evaluate cognitive functioning (Syndrom Kurztest), depressive symptomatology (Montgomery-Asberg Depression Rating Scale), posttraumatic stress symptoms (Posttraumatic Stress Syndrome 10-Questions Inventory) and HRQOL (SF-36 Health Status Questionnaire). Delirium Rating Scale (DRS) was used daily over the course of intensive care unit treatment. Postoperative delirium developed in 11 of the 34 patients (mean DRS rating scale score+/-S.D.: 20.36+/-6.22, range: 14-31). Short-term consequences of cardiac surgery included adjustment disorder with depressed features (n=11), posttraumatic stress disorder (n=6), major depression (n=6) and clinically relevant cognitive deficits (n=13). At 12 months, the severity of depression and anxiety disorders improved and returned to the preoperative level, and 6 out of the 30 followed-up patients displayed cognitive deficits. Our patients' HRQOL SF-36 self-reports significantly improved compared with baseline quality of life data. However, 1-year overall lower cognitive function scores were associated with lower HRQOL. Cardiac surgery with CPB is associated with improvements in HRQOL relative to the preoperative period, but the presence of cardiac surgery-related cognitive decline impairing HRQOL is a complication for a subgroup of cardiac surgical patients in the long-term outcome.
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Way P, Fairbrother G, Grguric S, Broe J. The relative benefits of pre-operative clinic vs on admission approaches to preparing patients for elective cardiac surgery. Aust Crit Care 2003. [DOI: 10.1016/s1036-7314(03)80017-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pignay-Demaria V, Lespérance F, Demaria RG, Frasure-Smith N, Perrault LP. Depression and anxiety and outcomes of coronary artery bypass surgery. Ann Thorac Surg 2003; 75:314-21. [PMID: 12537248 DOI: 10.1016/s0003-4975(02)04391-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Psychological and psychiatric disorders independently increase the risk of cardiovascular disease and worsen the prognosis in patients with established cardiovascular lesions. The objective of this literature review is to discuss recent data concerning the relationships between depression and anxiety and the outcomes of coronary artery bypass grafting. Pathophysiological hypotheses are put forward to explain observed links. We suggest recommendations aimed at improving the psychological evaluation and management of heart surgery candidates, as well as postbypass patients, in the hope of improving quality of life and cardiovascular outcomes in these patients.
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Andrew MJ, Baker RA, Kneebone AC, Knight JL. Mood state as a predictor of neuropsychological deficits following cardiac surgery. J Psychosom Res 2000; 48:537-46. [PMID: 11033372 DOI: 10.1016/s0022-3999(00)00089-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES mood disorders and neuropsychological deficits are both commonly reported occurrences after cardiac surgery. We examined the relationship between mood state and postoperative cognitive deficits in this population. METHODS assessments of neuropsychological functions and mood state (depression, anxiety, stress scales; DASS) were performed preoperatively and postoperatively on 147 patients undergoing cardiac surgery. RESULTS the incidence of preoperative depression, anxiety, and stress symptomatology was 16%, 27%, and 16%, respectively. The incidence of postoperative anxiety symptomatology significantly increased to 45% (p<0.001), while the incidence of depression and stress symptomatology remained stable (19% and 15%, respectively; ns). Changes in mood state did not influence changes in neuropsychological performance. Preoperative mood was a strong predictor of postoperative mood, and was related to postoperative deficits on measures of attention and memory. CONCLUSIONS an assessment of preoperative mood is critical in identifying patients at risk of postoperative mood disorders and neuropsychological deficits. Measures assessing somatic manifestations of anxiety may not be suitable for a surgical population.
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Affiliation(s)
- M J Andrew
- Cardiac Surgical Research Group, Department of Medicine, Flinders Medical Centre and Flinders University of South Australia, Bedford Park, South Australia 5042, Adelaide, Australia
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