Guideline-based early rehabilitation after myocardial infarction. A pragmatic randomised controlled trial. Educational Intervention Reduces Complications and Rehospitalizations After Heart Surgery Randomized controlled trial of brief cognitive behavioral intervention for depression and anxiety symptoms preoperatively in patients undergoing coronary artery bypass graft surgery. Timing for Delivering Individualized Patient Education Intervention to Coronary Artery Bypass Graft Patients: An RCT Video information combined with individualized information sessions: Effects upon emotional well-being following coronary artery bypass surgery--A randomized trial. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery? Effects of a health education programme with telephone follow-up during cardiac rehabilitation. Brief psychological intervention in phase I of cardiac rehabilitation after acute coronary syndrome. Early education and counselling of patients with acute coronary syndrome. A pilot study for a randomized controlled trial A randomized clinical trial of nursing care for recovery from cardiac surgery. Comparing multifactorial lifestyle interventions and stress management in coronary risk reduction Preoperative patient education for open-heart patients: a source of anxiety? Randomized Controlled Trial of Tailored Nursing Interventions to Improve Cardiac Rehabilitation Enrollment [The effect of psychosocial rehabilitation after acute myocardial infarction. A randomized controlled trial]. Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial A randomized, controlled trial of vicarious experience through peer support for male first-time cardiac surgery patients: impact on anxiety, self-efficacy expectation, and self-reported activity. Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic Americans.
OBJECTIVES To determine the effectiveness of individualised educational behavioural treatment delivered by cardiac nurses in hospital compared to usual care for patients following acute myocardial infa rct ion . METHODS One hundred and fourteen consecutive patients were r and omised to receive the intervention or usual care . Outcome assessment was by self-report question naire ( the Hospital Anxiety and Depression Scale and Dartmouth COOP Health Status ) , interview at 1 month , and self-report at 3 and 12 months . The primary outcome was improvement in the Dartmouth COOP total score from baseline to 3 months . RESULTS Four patients needed to be treated to give an additional patient with improvement in health status at 3 months ( number needed to treat [ NNT ] 4 , 95 % confidence intervals [ CIs ] 3 to 12 ) . The intervention group were more confident about returning to activities 1 month after discharge from hospital . Treated patients had fewer further treatment needs . CONCLUSIONS An individualised educational behavioural treatment delivered by cardiac nurses in hospital may have substantial benefits . A large-scale pragmatic RCT is needed The effectiveness of in-hospital self-care patient education , delivered to patients following heart surgery , is question able , as evidence indicates individuals are not able to absorb and /or retain information at this time . In the absence of adequate instruction , individuals will not have the relevant information to engage in specific self-care behaviors , result ing in the onset of complications and /or hospital readmissions . The purpose of this pilot study was to collect preliminary evidence to demonstrate the impact of an individualized education intervention given above and beyond usual care , delivered , at two points in time , following hospital discharge . A r and omized controlled trial was used in which 34 patients were r and omly assigned to one of two groups . Chi-square analyses to examine differences between groups on complications and hospital readmission rates were conducted . Findings point to the impact of the intervention in reducing the number of hospital readmissions and complications at 3 months following hospital discharge OBJECTIVE The goal of this study was to examine the feasibility , acceptability , and efficacy of a brief , tailored cognitive-behavioral intervention for patients with symptoms of preoperative depression or anxiety before undergoing a coronary artery bypass graft ( CABG ) operation . METHODS Patients were recruited from a university teaching hospital between February 2007 and May 2009 . Patients were r and omly assigned to receive treatment as usual ( TAU ) or a cognitive behavioral therapy ( CBT ) intervention called Managing Anxiety and Depression using Education and Skills ( MADES ) . A total of 100 subjects were r and omized into the study . Length of hospital stay was assessed with a 1-way analysis of variance . Depression , anxiety , and quality of life were assessed with mixed-model repeated measures analyses . RESULTS Overall , the intervention was feasible , and patients had a positive impression of the MADES . Patients in the TAU group stayed longer in the hospital than did those in the MADES group ( 7.9 days ± 2.6 vs 9.2 days ± 3.5 ; P = .049 ) . Depressive symptoms increased at time of hospital discharge for the TAU group , whereas the MADES group had a decrease in depressive symptoms at the time of discharge . Quality of life and anxiety symptoms improved in both groups at 3 to 4 weeks of follow-up . However , the MADES group had greater improvements than did the TAU group . CONCLUSIONS This study demonstrated that brief , tailored CBT targeting preoperative depression and anxiety is both feasible and acceptable for patients undergoing CABG surgery . Most important , this intervention improved depressive and anxiety symptoms , as well as quality of life . Moreover , it reduced in-hospital length of stay . This study found that a cognitive-behavioral intervention for patients undergoing CABG surgery for symptoms of preoperative depression/anxiety is both feasible and acceptable . Most important , this intervention improved depressive and anxiety symptoms , as well as quality of life . It also reduced in-hospital length of stay Background : The primary focus of this study is on the timing of the delivery of education to patients who had CABG surgery . Aim : To determine the efficacy of an individualized telephone patient education intervention , delivered at two different points in time ( 1–2 days pre-discharge versus 1–2 days post-discharge ) in enhancing the CABG patient 's knowledge of self-care behaviours , performance of self-care behaviours , and symptom frequency . Method : A r and omized clinical trial that included a convenience sample of first time CABG patients . Individuals who received education pre-discharge were compared to individuals who received education post-discharge on the outcomes . Results : Results indicated no statistically significant difference in outcomes between the two time points . As well , anxiety levels were found to be significantly higher in the pre-discharge group than the post-discharge group . Conclusions : The individualized nature of the educational intervention may have accounted for non-significant findings reported in outcomes between the two time points . Practice implication s : Nurses may consider assessing anxiety levels prior to delivery of educational interventions , implement interventions aim ed at reducing anxiety levels , and provide individualized teaching OBJECTIVE To test the efficacy of an information intervention upon emotional recovery following coronary artery bypass surgery . METHODS R and omized trial .  Video information was combined with individualized information sessions carried out by nurses at admission and at discharge from the hospital . The video was shown pre-operatively and again during the session at admission . Patients were helped to express their questions and worries and congruent information and support was provided . Control group patients received st and ardized information and no video . Recordings were made at baseline , discharge from hospital and during a 2 years follow-up period . RESULTS One hundred and nine patients were r and omized to the intervention or the control groups . A MANOVA was used to test of the variance of the outcome variables at each time point . At discharge intervention patients reported less anxiety ( p = 0.046 ) and better subjective health ( p = 0.005 ) . They reported better subjective health during the whole follow-up period ( 0.040 > or = p > or = 0.000 ) , less anxiety up to 1 year ( 0.042 > or = p > or = 0.004 ) , and less depression from 6 months to 2 years following discharge ( 0.023 > or = p > or = 0.004 ) . CONCLUSION The effects of the intervention probably relate to the combined use of the video and patient centered information sessions . PRACTICE IMPLICATION S The intervention can easily be implemented in clinical practice and nurses strongly identified with its principles Background : The effect of preoperative education on anxiety and postoperative outcomes of cardiac surgery patients remains unclear . Aim : The aim of the study was to estimate the effectiveness of a nurse-led preoperative education on anxiety and postoperative outcomes . Methods : A r and omised controlled study was design ed . All the patients who were admitted for elective cardiac surgery in a general hospital in Athens with knowledge of the Greek language were eligible to take part in the study . Patients in the intervention group received preoperative education by specially trained nurses . The control group received the st and ard information by the ward personnel . Measurements of anxiety were conducted on admission-A , before surgery-B and before discharge-C by the state – trait anxiety inventory . Results : The sample consisted of 395 patients ( intervention group : 205 , control group : 190 ) . The state anxiety on the day before surgery decreased only in the intervention group ( 34.0 ( 8.4 ) versus 36.9 ( 10.7 ) ; P=0.001 ) . The mean decrease in state score during the follow-up period was greater in the intervention group ( P=0.001 ) . No significant difference was found in the length of stay or readmission . Lower proportions of chest infection were found in the intervention group ( 10 ( 5.3 ) versus 1 ( 0.5 ) ; P=0.004 ) . Multivariate linear regression revealed that education and score in trait anxiety scale on admission are independent predictors of a reduction in state anxiety . Conclusion : Preoperative education delivered by nurses reduced anxiety and postoperative complications of patients undergoing cardiac surgery , but it was not effective in reducing readmissions or length of stay A health education and counselling programme was offered to myocardial infa rct ion patients during and after hospitalization . A r and omized pre-test-post-test control group design was used to evaluate the effects of the experimental intervention . During hospitalization the intervention consisted of two individual counselling sessions and two group health education sessions focusing on medication , healthy habits , anxiety and depression . On completion of these sessions , weekly telephone calls were made to patients for a period of six weeks after discharge from hospital . The intervention was offered to 30 myocardial infa rct ion patients and their partners ( the experimental group ) in addition to  st and ard medical care . Thirty control patients received st and ard medical care only . Two months after myocardial infa rct ion , patients in the experimental condition reported a significantly greater increase in physical activity , and a significantly greater decrease in unhealthy eating habits . No effects were found regarding smoking cessation , anxiety and depression . Twelve months after discharge from hospital patients in the experimental condition reported a significantly greater decrease in unhealthy eating habits . No effects were found regarding smoking cessation , physical activity , anxiety and depression . In addition , two months after myocardial infa rct ion , it was found that patients whose partners participated in the health education sessions showed a significantly greater decrease in smoking and unhealthy eating habits and a significantly greater increase in physical activity than patients with no partner participating . Twelve months after discharge the only significant result favouring the patients whose partner participated in the health education sessions concerned smoking cessation INTRODUCTION Acute coronary syndrome ( ACS ) is an important cause of mortality and significant personal and financial costs . Cardiac rehabilitation ( CR ) programs have shown positive effects in reducing cardiovascular mortality and improving functional capacity . However , adherence is low and appears to be influenced by psychosocial factors , such as patients ' cognitions and emotional state . The objective was to evaluate the efficacy of a brief in-hospital psychological intervention to promote cognitive and emotional adaptation after ACS . METHODS One hundred and twenty-one patients with ACS , admitted to a coronary care unit in a central hospital , were r and omized to an experimental group ( EG , n=65 ) and a control group ( CG , n=56 ) . Portuguese versions of the HADS and BIPQ  were used to measure emotional well-being and illness cognitions . Two 1 h 15 min sessions were conducted 2 - 3 days after hospital admission , and a 20-minute follow-up session took place one month after discharge . Patients were assessed at four different time points : pre-test , post-test , and at 1- and 2-month follow-up . RESULTS The intervention had significant effects on anxiety , depression and illness cognitions . Anxiety and depression were significantly reduced and illness cognitions improved significantly in the EG compared to the control group . For the EG , these changes were maintained or enhanced at 1- and 2-month follow-up , whereas for the CG there was a deterioration in psychosocial adjustment . CONCLUSIONS These results indicate that a brief psychological intervention program delivered during hospitalization for ACS and combined with st and ard medical care can have positive effects in terms of psychosocial outcomes that have proven impact on cardiac rehabilitation and prognosis Background : At time of discharge , patients with acute coronary syndrome often have a knowledge deficit regarding their disease , further treatment and necessary behavioural changes . It is well known that self-efficacy as a prerequisite for behavioural changes can be influenced by patient education . This study investigated whether an individualized education programme starting early in the cardiac care unit enhanced self-efficacy and rehabilitation programme attendance , and was feasible and satisfying for patients . Methods and design : In a pilot r and omized controlled trial , 40 patients with acute coronary syndrome were enrolled . The intervention group received in addition to st and ard care an early individual needs-oriented educational session in the cardiac care unit and subsequently one on the ward addressing risk factors , medication and self-management as well as referral to a rehabilitation programme by a nurse . Self-efficacy  was assessed twice , at attendance in a rehabilitation programme six weeks after discharge . The participants ’ satisfaction with the intervention was assessed qualitatively . Results : When controlling for anxiety and depression , the intervention group showed significant better self-efficacy scores on the ability to control the symptoms ( p=0.034 ) . When controlling additionally for age , no significant differences could be detected . The attendance of a rehabilitation programme was higher in the intervention group . The participants in the intervention group reported high satisfaction with the early education . Conclusion : Early education seems to benefit patients with acute coronary syndrome . In light of increased confidence to control one ’s symptoms and the higher attendance in rehabilitation programmes , as well as a high satisfaction with the intervention , a full powered study will be pursued OBJECTIVE To determine the efficacy of a psychoeducational nursing intervention in patients who receive coronary artery bypass graft and valve repair surgery . DESIGN A cluster-r and omized controlled trial design . SETTING Two hospitals in the western United States -- a large community hospital with an active cardiovascular surgery practice and a health-sciences research center . SUBJECTS 156 patients between 25 and 75 years of age , 125 ( 81.1 % ) men , and 31 ( 19.9 % ) women , all with primary care givers . OUTCOME MEASURES Self-efficacy expectations , activities ( behavior performance ) , quality of life , mood state . INTERVENTION Supplemental in-hospital education followed by telephone contact from discharge to eighth week after discharge . RESULTS Patients in the experimental group reported significantly greater self-efficacy expectations for walking and behavior performance for walking , lifting , climbing stairs , general exertion and , where applicable , for working . CONCLUSION This trial suggests that a low-intensity psychoeducational nursing intervention can promote self-efficacy expectations for walking in recovery and is associated with more self-reported walking and lifting behavior after cardiac surgery The aim of this study was to compare the effects of residential multifactorial cardiac rehabilitation , outpatient multifactorial rehabilitation , stress management , and st and ard coronary rehabilitation , on cardiac risk reduction . Out of 144 eligible male patients recently treated with percantaneous transluminal coronary angiography ( PTCA ) , coronary artery bypass graft ( CABG ) , or acute myocardial infa rct ion ( AMI ) , 132 were r and omized into this study . All interventions covered a 12-month active intervention , intense during the first months and subsequently leveled out . Main assessment s were performed before r and omization and after the intervention . Patients offered behavioral rehabilitation showed improved selfreported healthy diet habits and exercise frequency , and higher internal locus of control . Although blood lipids , exercise capacity , body mass , anxiety , depression , and Type A scores were changed in the expected direction , no significant difference emerged between active intervention and the st and ard care condition . St and ard care of today appears to have great potential in particular if supplemented with some kind of stress management OBJECTIVE The purpose of this study was to assess the impact of preoperative patient education on anxiety and recovery of the Lebanese patients undergoing open-heart surgery . METHODS This quasi-experimental study was conducted at a large hospital in Beirut , which is a university hospital . All patients who were admitted to the cardiac surgery unit and who met the inclusion criteria were r and omly assigned to as experimental or a control group . The patients in the experimental group ( n = 57 ) received a special educational session on their admission day and had a tour of the cardiac surgery unit . The control group ( n = 53 ) followed the routine hospital protocol , which encompassed almost no preoperative education or a tour .  Anxiety was assessed using the Beck Anxiety Inventory while recovery was measured by physiological outcomes , days of hospital stay , and presence of complications . A Multivariate Analysis of Covariance ( MANCOVA ) was performed with adjustment for potential confounding variables . RESULTS Borderline statistical significance was noted for the experimental group in terms of preoperative and postoperative anxiety . The experimental group had a shorter time from awakening to extubation . CONCLUSION Unlike most studies published previously , which noted the benefits of preoperative patient education , this study with the Lebanese clients , failed to support earlier findings . PRACTICE IMPLICATION S The results suggest that patient education should not be initiated before assessing the patient 's cultural and social background Background : Short hospital stays for patients with acute coronary syndromes ( ACSs ) reduce the opportunity for risk factor intervention during admission . After discharge , cardiac rehabilitation can decrease the recurrence of coronary events by up to 25 % . However , it remains underused . Objectives : The aim of this study was to determine whether a nursing intervention focused on individual ACS patients ’ perceptions of their disease and treatment would increase rehabilitation enrollment after discharge . Method : A total of 242 ACS patients admitted to a specialized tertiary cardiac center were r and omized to either the intervention or  usual care  ( n = 121 in both groups ) . The intervention included one nurse – patient meeting before discharge with 2 additional contacts over the 10 days after discharge ( mean duration = 40 minutes per contact ) . The primary outcome was enrollment in a free rehabilitation program offered to all participants 6 weeks after discharge . Secondary outcomes included illness perceptions ; family support ; anxiety level ; medication adherence ; and cardiac risk factors including lack of exercise , smoking , body mass index , and diet . Results : The sample was composed of a majority of male , married workers who experienced a myocardial infa rct ion or unstable angina without severe complications . The mean hospital stay in both groups was 3.6 days . There was a significantly higher rate of rehabilitation enrollment in the intervention group ( 45 % ) than in the control group ( 24 % ; p = .001 ) . For the secondary outcomes , only the personal control dimension of illness perceptions was improved significantly with the intervention . Discussion : Progressive , individualized interventions by nurses result ed in greater rehabilitation enrollment , thereby potentially improving long-term outcome INTRODUCTION The aim of the study was to examine the effect of group based psychosocial rehabilitation following discharge compared to usual care . MATERIAL AND METHODS A r and omised clinical trial was performed in the setting of a coronary unit at Herlev University Hospital . The study sample included 200 patients admitted to the unit with a diagnosis of acute myocardial infa rct ion . All patients received usual care .  Besides , the intervention group was offered two group based outpatient counselling sessions with focus on reduction of risk factors and psychosocial adjustment after myocardial infa rct ion . Coping strategies , anxiety and depression , general health , physical function and number of readmissions were measured on the basis of the question naires HAD and mini-MAC . Participants completed question naires before discharge and again six weeks and four months after discharge . RESULTS The intervention did not significantly affect coping strategies , general health or physical function . The readmission rate was significantly lower in the intervention group compared to the control group . The mortality rate in the intervention group was lower after four months , one year and four years . DISCUSSION Possible explanations for the lack of effect in psychosocial parameters are the complex target group with no restrictions in gender and age and no intervention targeted the relatives . The lower mortality rate in the intervention group might be due to the intervention . However , it could also be due to variables not available in this study , such as the type of infa rct ion and changes in lifestyle Abstract Objective : To evaluate rehabilitation  after myocardial infa rct ion . Design : R and omised controlled trial of rehabilitation in unselected myocardial infa rct ion patients in six centres , baseline data being collected on admission and by structured interview ( of patients and spouses ) shortly after discharge and outcome being assessed by structured interview at six months and clinical examination at 12 months . Setting : Six district general hospitals . Subjects : All 2328 eligible patients admitted over two years with confirmed myocardial infa rct ion and discharged home within 28 days . Interventions : Rehabilitation programmes comprising psychological therapy , counselling , relaxation training , and stress management training over seven weekly group outpatient sessions for patients and spouses . Main outcome measures : Anxiety , depression , quality of life , morbidity , use of medication , and mortality . Results : At six months there were no significant differences between rehabilitation patients and controls in reported anxiety ( prevalence 33 % ) or depression ( 19 % ) . Rehabilitation patients reported a lower frequency of angina ( median three versus four episodes a week ) , medication , and physical activity . At 12 months there were no differences in clinical complications , clinical sequelae , or mortality . Conclusions : Rehabilitation programmes based on psychological therapy , counselling , relaxation training , and stress management seem to offer little objective benefit to patients who have experienced myocardial infa rct ion compared with previous reports of smaller trials . Key messages In this series there were no important differences by age , sex , hospital , or baseline anxiety or depression At six months the prevalence rates of clinical anxiety and depression remained high ( 33 % and 19 % respectively ) Patients and spouses rated programmes highly , which suggests a “ quality of care ” role for OBJECTIVES The purpose of this study was to determine whether vicarious experience , in which former patients exemplify the active lives they are leading , reduces anxiety and increases self-efficacy expectation and self-reported activity in patients after cardiac surgery . DESIGN A r and omized , controlled trial was used to evaluate an intervention that linked volunteers who had recovered from cardiac surgery in dyadic support with patients about to undergo similar surgery . The linking was achieved by means of visits during the hospitalization and recovery period . SUBJECTS Fifty-six first-time male patients undergoing coronary artery bypass graft ( CABG ) surgery , with a mean age of 56.5 years , were r and omly assigned to an experimental ( n = 27 ) or control group ( n = 29 ) . OUTCOME MEASURES Anxiety was measured at 48 hours and 24 hours before surgery , and again at 5 days and 4 weeks after surgery . Self-efficacy expectation and self-reported activity were both evaluated at 5 days and 4 weeks after surgery . RESULTS Only the experimental group showed a significant decrease in anxiety during hospitalization . At all measurement times after the first intervention , the experimental group reported significantly lower levels of anxiety compared with the control group . The experimental group reported significantly higher levels of self-efficacy expectation and self-reported activity for general activities , walking , and climbing stairs evaluated at 5 days , and for general activities at 4 weeks after surgery . CONCLUSIONS Vicarious experience provided through dyadic support is effective in helping patients undergoing cardiac surgery cope with surgical anxiety and in improving self-efficacy expectations and self-reported activity after surgery . Dyadic support is a valuable tool for recovery from cardiac surgery that needs to be maintained and explored through nursing practice and research OBJECTIVE To evaluate the effect of 2 post-bariatric support interventions on depressive symptoms of Hispanic Americans treated with gastric bypass for morbid or severe obesity . DESIGN / SETTING Prospect i ve r and omized , controlled trial conducted in a laparoscopic institution . PARTICIPANTS / INTERVENTIONS During the Phase 1 clinical trial ( from preoperative evaluation to 6 months after surgery ) , all participants received st and ard care . During Phase 2 ( 6 - 12 months after surgery ) , participants were r and omly assigned to receive either st and ard care ( n = 72 ) or comprehensive support ( n = 72 ) . Comprehensive group participants received 6 educational sessions focused on behavior change strategies and motivation with nutrition counseling . MAIN OUTCOME MEASURES Depression scores and weight change over time . ANALYSIS Independent sample s t tests and regression analysis assessed relationships among depression scores and excess weight loss . RESULTS Participants receiving behavioral-motivational intervention scored significantly lower on Beck 's Depression Inventory question naire scores than those receiving st and ard care . For those with depressive symptoms at r and omization , 24 % of participants who received the comprehensive intervention reported no depressive symptoms at 12 months after surgery , compared with 6 % of those who received st and ard care ( P < .001 ) . Patients ' depressive mood improvement was significantly and positively associated with excess weight loss and attendance at educational sessions ( P < .001 ) . CONCLUSIONS AND IMPLICATION S Findings support the importance of post-bariatric comprehensive behavioral-motivational nutrition education for decreasing risk for depression and improving weight loss
The findings from this systematic review suggest favorable effects on the readmission rates .
As well , the individualized patient education intervention is effective in promoting statistically significant changes in quality of life , performance of health behaviours , depression , and anxiety
The objective of this systematic review was to compare the effectiveness of individualized patient education interventions to st and ardized patient education interventions on the rate of readmission , performance of specific health behaviours , depression , anxiety , and cognition during the post-hospital discharge recovery period following cardiovascular surgery .