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Lifestyle practices, health problems, and quality of life after coronary artery bypass grafting.

ABSTRACT: Introduction:Severe coronary artery disease continues to be a major health problem in India, and coronary artery bypass grafting (CABG) is the accepted modality of treatment. Post-operative long-term quality of life depends on the healthy lifestyle practices and appropriate control of risk factors. We tried to bring out the patient awareness and their practices after the surgery and their implications on their quality of life (QOL). Materials and methods:Five hundred patients who completed 6 months after isolated CABG were interrogated for their lifestyle practices, health problems, and quality of life using a structured questionnaire. Those who underwent additional cardiac procedures, redo CABG, and coronary interventions after CABG were excluded. Results:Eighty percent were in good functional class (NYHA I, II). Detailed evaluation showed that only 11.6% adhered to healthy lifestyle practices. Obesity, uncontrolled diabetes mellitus, uncontrolled hypertension, and hypercholesterolemia continued to be problems in 9.6, 20.2, 35, and 48.4%, respectively. Quality of life was assessed to be good in 27.6%, average in 46.4%, and poor in 26%. Psychological evaluation showed that 23% were significantly anxious and 20% had significant depression. Pre-operative diagnosis and left ventricular function at discharge influenced the QOL. Unhealthy lifestyle practices and failure to attain risk factor reduction adversely affected the quality of life. Conclusion:This study emphasises the need for aggressive counselling as well as continuing health education to improve patient awareness about adopting healthy lifestyle practices after CABG to improve the quality of life.

SUBMITTER: Nair VV

PROVIDER: S-EPMC7525532 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Lifestyle practices, health problems, and quality of life after coronary artery bypass grafting.

Nair Vinitha Viswambharan VV Nair Jayakumar Thanathu Krishnan JTK Das Shyam S Singh Kunal Krishna KK Kathayanat Joseph Thomas JT Radhakrishnan Ratish R Chooriyil Nidheesh N Babu Akash A

Indian journal of thoracic and cardiovascular surgery 20180402 4

<h4>Introduction</h4>Severe coronary artery disease continues to be a major health problem in India, and coronary artery bypass grafting (CABG) is the accepted modality of treatment. Post-operative long-term quality of life depends on the healthy lifestyle practices and appropriate control of risk factors. We tried to bring out the patient awareness and their practices after the surgery and their implications on their quality of life (QOL).<h4>Materials and methods</h4>Five hundred patients who ...[more]

PMID: 33060919

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Project description:BACKGROUND:To date, studies evaluating outcome improvements associated with participation in physician-led collaboratives have been limited by the absence of a contemporaneous control group. We examined post cardiac surgery pneumonia rates associated with participation in a statewide, quality improvement collaborative relative to a national physician reporting program. METHODS AND RESULTS:We evaluated 911 754 coronary artery bypass operations (July 1, 2011, to June 30, 2017) performed across 1198 hospitals participating in a voluntary national physician reporting program (Society of Thoracic Surgeons [STS]), including 33 that participated in a Michigan-based collaborative (MI-Collaborative). Unlike STS hospitals not participating in the MI-Collaborative (i.e., STSnonMI) that solely received blinded reports, MI-Collaborative hospitals received a multi-faceted intervention starting November 2012 (quarterly in-person meetings showcasing unblinded data, webinars, site visits). Eighteen of the MI-Collaborative hospitals received additional support to implement recommended pneumonia prevention practices ("MI-CollaborativePlus"), whereas 15 did not ("MI-CollaborativeOnly"). We evaluated rates of postoperative pneumonia, adjusting for patient mix and hospital effects. Baseline patient characteristics were qualitatively similar between groups and time. During the preintervention period (Q3/2011 through Q3/2012), there was no statistically significant difference in the adjusted odds of pneumonia for STS hospitals participating in the MI-Collaborative compared to the STS non-MI hospitals. However, during the intervention period (Q4/2012 through Q2/2017), there was a significant 2% reduction per quarter in the adjusted odds of pneumonia for MI-Collaborative hospitals (n=33) relative to the STS-nonMI hospitals. There was a significant 3% per quarter reduction in the adjusted odds of pneumonia for the MI-CollaborativeOnly (n=15) hospitals relative to the STS-nonMI hospitals. Over the course of the overall study period, the STS-nonMI hospitals had a 1.96% reduction in risk-adjusted pneumonia (pre- vs. intervention periods), which was less than the MI-Collaborative (3.23%, P=0.011). Over the same time period, the MI-CollaborativePlus (n=18) reduced adjusted pneumonia rates by 10.29%, P=0.001. CONCLUSIONS:Participation in a physician-led collaborative was associated with significant reductions in pneumonia relative to a national quality reporting program. Interventions including collaborative learning may yield superior outcomes relative to solely using physician feedback reporting. CLINICAL TRIAL REGISTRATION:URL: https://www.clinicaltrials.gov . Unique identifier: NCT02068716.

Project description:Background Over 180 000 coronary artery bypass grafting (CABG) procedures are performed annually, accounting for $7 to $10 billion in episode expenditures. Assessing tradeoffs between spending and quality contributing to value during 90-day episodes has not been conducted but is essential for success in bundled reimbursement models. We, therefore, identified determinants of variability in hospital 90-day episode value for CABG. Methods Medicare and private payor admissions for isolated CABG from 2014 to 2016 were retrospectively linked to clinical registry data for 33 nonfederal hospitals in Michigan. Hospital composite risk-adjusted complication rates (≥1 National Quality Forum-endorsed, Society of Thoracic Surgeons measure: deep sternal wound infection, renal failure, prolonged ventilation >24 hours, stroke, re-exploration, and operative mortality) and 90-day risk-adjusted, price-standardized episode payments were used to categorize hospitals by value by defining the intersection between complications and spending. Results Among 2573 total patients, those at low- versus high-value hospitals had a higher percentage of prolonged length of stay >14 days (9.3% versus 2.4%, P=0.006), prolonged ventilation (17.6% versus 4.8%, P<0.001), and operative mortality (4.8% versus 0.6%, P=0.001). Mean total episode payments were $51 509 at low-compared with $45 526 at high-value hospitals (P<0.001), driven by higher readmission ($3675 versus $2177, P=0.005), professional ($7462 versus $6090, P<0.001), postacute care ($7315 versus $5947, P=0.031), and index hospitalization payments ($33 474 versus $30 800, P<0.001). Among patients not experiencing a complication or 30-day readmission (1923/2573, 74.7%), low-value hospitals had higher inpatient evaluation and management payments ($1405 versus $752, P<0.001) and higher utilization of inpatient rehabilitation (7% versus 2%, P<0.001), but lower utilization of home health (66% versus 73%, P=0.016) and emergency department services (13% versus 17%, P=0.034). Conclusions To succeed in emerging bundled reimbursement programs for CABG, hospitals and physicians should identify strategies to minimize complications while optimizing inpatient evaluation and management spending and use of inpatient rehabilitation, home health, and emergency department services.

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Lifestyle practices, health problems, and quality of life after coronary artery bypass grafting.

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Lifestyle practices, health problems, and quality of life after coronary artery bypass grafting.

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