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Secondary Prevention Following Coronary Artery Bypass Surgery: A Pilot Study for Improved Patient Education

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DOI: 10.4236/ijcm.2012.34056    4,128 Downloads   5,728 Views   Citations

ABSTRACT

Background: Sustained positive outcomes after coronary artery bypass grafting (CABG) requires risk factor modification and secondary prevention medications. Much attention has been focused on planning at hospital discharge; however longer-term patient compliance is not well described. Hypothesis: A follow-up multidisciplinary educational program improves disease understanding, motivation to reduce cardiovascular risk, and secondary prevention medication prescribing following hospital discharge. Methods: Using a prospective, randomized, controlled design, patients undergoing CABG completed surveys over a year period, assessing disease understanding and motivation. Four to six weeks after CABG, intervention subjects completed a one-time educational program with a multidisciplinary team. The primary endpoint was a composite score of reduced risk factors, medication use, and awareness of prescribed medications. Secondary endpoints evaluated survey scores and medication use rates. Wilcoxon Rank Sum and Chi Square tests compared data between specific time points. Generalized estimating equations and linear contrasts of the parameter estimates compared data at the three time points. Results: The final analysis included 98 subjects (Intervention = 49, Control = 49). The composite score was not different between groups (I = 12.8 ± 4.5 points, C = 12.7 ± 4.9 points, p = 0.9405). Improvements were noted in understanding and motivation in the entire cohort, but these changes were not influenced by the intervention. Medication prescribing declined at 3 and 12 months after CABG without significant differences between the groups. Conclusions: Disease understanding, motivation to reduce risk, and medication use are robust at hospital discharge but the latter declines with time and was not improved by our intervention. These findings are concerning and warrant further study.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

J. B. Kramer, P. A. Howard, B. J. Barnes, B. Ababneh, P. Mukhopadhyay, M. Biria, G. F. Muehlebach, E. Daon, G. L. Zorn, W. A. Reed and J. L. Vacek, "Secondary Prevention Following Coronary Artery Bypass Surgery: A Pilot Study for Improved Patient Education," International Journal of Clinical Medicine, Vol. 3 No. 4, 2012, pp. 286-294. doi: 10.4236/ijcm.2012.34056.

References

[1] T. B. Ferguson Jr., B. G. Hammill, E. D. Peterson, E. R. De Long and F. L. Grover, “A Decade of Change—Risk Profiles and Outcomes for Isolated Coronary Artery By-pass Grafting Procedures, 1990-1999: A Report from the Society of Thoracic Surgeons National Database Committee and the Duke Clinical Research Institute,” The Annals of Thoracic Surgery, Vol. 73, No. 2, 2002, pp. 480-490. doi:10.1016/S0003-4975(01)03339-2
[2] The Society of Thoracic Surgeons, “STS Adult Cardiac Surgery Database Executive Summary 10 Years—Period ending 3/31/2010,” 2011. http://www.sts.org/sites/default/files/documents/20112ndHarvestExecutiveSummary.pdf
[3] A. Goyal, J. H. Alexander, G. E. Hafley, et al., “Outcomes Associated with Use of Secondary Prevention Medications after Coronary Artery Bypass Surgery,” The Annals of Thoracic Surgery, Vol. 83, No. 3, 2007, pp. 993-1001. doi:10.1016/j.athoracsur.2006.10.046
[4] S. C. Smith, J. Allen, S. N. Blair, et al., “AHA/ACC Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Disease: 2006 Update,” Circulation, Vol. 113, No. 19, 2006, pp. 2363-2372. doi:10.1161/CIRCULATIONAHA.106.174516
[5] R. H. Mehta, D. L. Bhatt, G. Steg, et al., “Modifiable Risk Factors Control and Its Relationship with 1 Year Outcomes after Coronary Artery Bypass Surgery: Insights from the REACH Registry,” European Heart Journal, Vol. 29, No. 24, 2008, pp. 3052-3060. doi:10.1093/eurheartj/ehn478
[6] T. B. Ferguson Jr., “Secondary Prevention after Coronary Artery Bypass Graft: A Primary Issue?” American Heart Journal, Vol. 147, No. 6, 2004, pp. 948-949. doi:10.1016/j.ahj.2003.12.024
[7] J. M. Foody, F. D. Ferdinand, D. Galusha, et al., “Patterns of Secondary Prevention in Older Patients Undergoing Coronary Artery Bypass Grafting during Hospitalization for Acute Myocardial Infarction,” Circulation, Vol. 108, Suppl. 2, 2003, pp. 24-28. doi:10.1161/01.cir.0000087654.26917.00
[8] D. Fox, M. Kibiro, J. Eichhofer and N. P. Curzen, “Patients Under-going Coronary Revascularisation: A Missed Opportunity for Secondary Prevention?” Postgraduate Medical Journal, Vol. 81, No. 956, 2005, pp. 401-403. doi:10.1136/pgmj.2004.023861
[9] P. J. Bradshaw, K. Jamrozik, I. Gilfillan and P. L. Thompson, “Preventing Recurrent Events Long Term after Coronary Artery Bypass Graft: Suboptimal Use of Medications in a Population Study,” American Heart Journal, Vol. 147, No. 6, 2004, pp. 1047-1053. doi:10.1016/j.ahj.2003.07.028
[10] K. Okrainec, L. Pilote, R. Platt and M. J. Eisenberg, “Use of Cardiovascular Medical Therapy among Patients Undergoing Coronary Artery Bypass Graft Surgery: Results from the RO-SETTA-CABG Registry,” The Canadian Journal of Cardiology, Vol. 22, No. 10, 2006, pp. 841- 847. doi:10.1016/S0828-282X(06)70302-6
[11] F. K. Yam, W. S. Akers, V. A. Ferraris, et al., “Interventions to Improve Compliance Following Coronary Artery Bypass Grafting,” Surgery, Vol. 140, No. 4, 2006, pp. 541-552. doi:10.1016/j.surg.2006.05.014
[12] L. F. Hiratzka, K. A. Eagle, L. Liang, G. C. Fonarow, K. A. LaBresh and E. D. Peterson, “Atherosclerosis Secondary Prevention Performance Measures after Coronary Artery Bypass Graft Surgery Compared with Percutaneous Catheter Intervention and Nonintervention Patients in the Get with the Guidelines Database,” Circulation, Vol. 116, Suppl. 1, 2007, pp. 207-212. doi:10.1161/CIRCULATIONAHA.106.681247
[13] A. J. Turley, A. P. Roberts, R. Morley, A. R. Thornley, W. A. Owens and M. A. deBelder, “Secondary Prevention Following Coronary Artery Bypass Grafting Has Improved but Remains Sup-Optimal: The Need for Targeted Follow-Up,” Interactive Cardiovascular and Thoracic Surgery, Vol. 7, No. 2, 2008, pp. 231-234. doi:10.1510/icvts.2007.168948
[14] J. B. Williams, E. R. DeLong, E. D. Peterson, R. S. Dokholyan, F. S. Ou and T. B. Ferguson, “Secondary Prevention after Coronary Artery Bypass Graft Surgery: Findings of a National Randomized Controlled Trial and Sustained Society-Led Incorporation into Practice,” Circulation, Vol. 123, No. 1, 2011, pp. 39-45. doi:10.1161/CIRCULATIONAHA.110.981068
[15] T. J. Gardner, “Can We Take Continuous Quality Improvement to the Next Level?” Circulation, Vol. 123, No. 1, 2011, pp. 8-9. doi:10.1161/CIRCULATIONAHA.110.002691
[16] U. Khanderia, K. A. Townsend, S. R. Erickson, J. Vlasnik, R. L. Prager and K. A. Eagle, “Medication Adherence Following Coronary Artery Bypass Graft Surgery: Assessment of Beliefs and Attitudes,” The Annals of Pharma-cotherapy, Vol. 42, No. 2, 2008, pp. 192-199. doi:10.1345/aph.1K497

  
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