Abstract

Ischemic heart failure (IHF) continues to have a major negative impact on quality of life after bypass surgery. Treatment approaches are needed to enhance post surgical recovery and home-based disease management self-efficacy for IHF patients. This study showed positive self-efficacy and disease-related outcomes of an automated home-based program for patients after bypass surgery. Background: Ischemic heart failure (IHF) is a common outcome of coronary artery disease (CAD). The primary intervention for IHF is coronary artery bypass grafting (CABG). Subsequent to CABG, IHF patients typically undergo numerous cardiac-related procedures to manage their ongoing disease process. Recent studies show that IHF continues to have a major negative impact on quality of life post-CABG. Treatment approaches are needed to enhance post surgical recovery and home-based disease management self-efficacy for IHF patients.

Methods: This clinical trial tested the effectiveness of a home communication intervention (HCI) for ischemic failure CABG patients 65 years of age and older. HCI is home-based support via an electronic communication device attached to patients' home telephones. HCI provides daily automated symptom management advice, CAD risk factor modification strategies, post-CABG recovery instructions, and positive reinforcement. Primary outcomes studied were self-efficacy, coronary artery disease (CAD) risk factor modification, and post-hospitalization functioning (i.e. physical, general health, mental health, vitality). 35 IHF CABG patients from a parent study were randomly allocated to either (a) HCI or (b) routine care for six weeks. Outcomes were evaluated upon hospital discharge and 3 months postdischarge.

Findings: The HCI group scored higher on self-efficacy to manage disease, functioning and exercise adherence compared to the routine care group 3 months post-CABG. HCI participants also reported lower stress levels at three months.

Conclusions: This pilot study demonstrated positive outcomes associated with an HCI program for post-CABG IHF patients. HCI has potential to provide ongoing home-based support to IHF and other cardiac patients with complex home support needs.

Reference: Barnason S., Zimmerman L., Nieveen J., Schmaderer M., Carranza B., Reilly S. Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning. Heart and Lung: The Journal of Acute and Critical Care 2003, May-June: 147-158.