title: Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery Educational Intervention Reduces Complications and Rehospitalizations After Heart Surgery Effects of education and support on self-care and resource utilization in patients with heart failure. The effect of a supportive educational intervention developed based on the Orem's self-care theory on the self-care ability of patients with myocardial infarction: a randomised controlled trial. The long-term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life. Video information combined with individualized information sessions: Effects upon emotional well-being following coronary artery bypass surgery--A randomized trial. Randomized trial of a home recovery intervention following coronary artery bypass surgery. Randomized controlled trial of a telephone intervention by nurses to provide information and support to patients and their partners after elective coronary artery bypass graft surgery: effects of anxiety. Enhancing Postoperative Recovery of Cardiac Surgery Patients Effects of a home-based intervention program on anxiety and depression 6 months after coronary artery bypass grafting: a randomized controlled trial. HeartCare: an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery. Impact of an early recovery management intervention on functioning in postoperative coronary artery bypass patients with diabetes. Recovery after coronary artery bypass surgery: effect of an audiotape information programme. A supportive-educative telephone program: impact on knowledge and anxiety after coronary artery bypass graft surgery. Designing and Testing Telehealth Interventions to Improve Outcomes for Cardiovascular Patients A Randomised Controlled Trial to Evaluate a Nurse-Led Programme of Support and Lifestyle Management for Patients Awaiting Cardiac Surgery: ‘Fit for Surgery: Fit for Life’ Study Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation. A “two-step” educational approach for patients taking oral anticoagulants does not improve therapy control Cardiac Home Education and Support Trial (CHEST): a pilot study. Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations. Coronary risk factor modification in women after coronary artery bypass surgery. The effects of a PRECEDE-based educational program on depression, general health, and quality of life of coronary artery bypass grafting patients. A comparison of patient teaching outcomes among postoperative coronary artery bypass graft (CABG) patients. Long-term effects of an expanded cardiac rehabilitation programme after myocardial infarction or coronary artery bypass surgery: a five-year follow-up of a randomized controlled study Effects of an intervention on health behaviors of older coronary artery bypass (CAB) patients. 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. Effects of preventive group education on the resistance of LDL against oxidation and risk factors for coronary heart disease in bypass surgery patients Discharge training and counselling increase self-care ability and reduce postdischarge problems in CABG patients. Nurse led shared care for patients on the waiting list for coronary artery bypass surgery: a randomised controlled trial Coronary artery bypass graft surgery patients and their family member caregivers: outcomes of a family-focused staged psychoeducational intervention. Effects of progressive muscular relaxation training on quality of life in anxious patients after coronary artery bypass graft surgery. Predictors of Smoking Cessation after Coronary Artery Bypass Graft Surgery: Results of a Randomized Trial with 5-Year Follow-up Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial.
abstract: & NA ; Cardiovascular diseases cause more disability and economic loss in industrialized nations than any other group of diseases . In previous work [ Nurs Res 49 ( 2000a ) 1 ] , most coronary artery bypass graft patients ( CABG , N=225 ) reported unrelieved pain and received inadequate analgesics . This study proposed to evaluate a preadmission education intervention to reduce pain and related activity interference after CABG surgery . Patients ( N=406 ) were r and omly assigned to ( a )  st and ard care or ( b ) st and ard care+pain booklet group . Data were examined at the preadmission clinic and across days 1–5 after surgery . Outcomes were pain‐related interference ( BPI‐I ) , pain ( MPQ‐SF ) , analgesics ( chart ) , concerns about taking analgesics ( BQ‐SF ) , and satisfaction ( American Pain Society‐POQ ) . The impact of sex was explored related to primary and secondary outcomes . The intervention group did not have better overall pain management although they had some reduction in pain‐related interference in activities ( t(355)=2.54 , P<0.01 ) and fewer concerns about taking analgesics ( F(1,313)=2.7 , P<0.05 ) on day 5 . Despite moderate 24‐h pain intensity across 5 days , patients in both groups received inadequate analgesics ( i.e. 33 % prescribed dose ) . Women reported more pain and pain‐related interference in activities than men . The booklet was rated as helpful , particularly by women . In conclusion , the intervention did not result in a clinical ly significant improvement in pain management outcomes . In future , an intervention that considers sex‐specific needs and also involves educating the health professionals caring for these patients may influence these results 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 AIMS To test the effect of education and support by a nurse on self-care and re source utilization in patients with heart failure . METHODS A total of 179 patients ( mean age 73 , 58 % male , NYHA III-IV ) hospitalized with heart failure were evaluated prospect ively . Patients were r and omized to the study intervention or to ' care as usual '  . The supportive educative intervention consisted of intensive , systematic and planned education by a study nurse about the consequences of heart failure in daily life , using a st and ard nursing care plan developed by the research ers for older patients with heart failure . Education and support took place during the hospital stay and at a home visit within a week of discharge . Data were collected on self-care abilities , self-care behaviour , readmissions , visits to the emergency heart centre and use of other health care re sources . RESULTS Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure . Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge , but the increase in the intervention group was significantly more after 1 month . Although self-care behaviour in both groups decreased during the following 8 months , the increase from baseline remained statistically significant in the intervention group , but not in the control group . No significant effects on re source utilization were found . CONCLUSIONS Intensive , systematic , tailored and planned education and support by a nurse results in an increase in patients ' self-care behaviour . No significant effects were found on use of health care re sources . Additional organisational changes , such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support AIMS AND OBJECTIVES The aim of this study was to assess the effect of a supportive educational intervention developed based on the Orem 's self-care theory on the self-care ability of patients with myocardial infa rct ion . BACKGROUND Patients with cardiovascular disease suffer from the lack of knowledge about the disease and consequently are not able to fulfil their own self-care needs . DESIGN This was a r and omised controlled trial conducted in 2012 . METHODS We recruited a r and om sample of 66 patients with myocardial infa rct ion who had been recently discharged from coronary care unit . The study setting was two university hospitals located in Khorasan , Iran . Patients were r and omly allocated to either the experimental or the control groups . Patients in the experimental group received education , support , and counselling while patients in the control group received no intervention . We employed a demographic question naire and the Myocardial Infa rct ion Self-Care Ability Question naire for data collection and spss version 16.00 for data analysis . FINDINGS After the study , patients in the experimental group had higher levels of self-care knowledge , motivation and skills compared to the pre study readings and the control group . CONCLUSION The supportive educational intervention developed based on the Orem 's self-care theory can improve nonhospitalised patients ' self-care ability and positively affect public health outcomes . Consequently , using the developed programme for providing follow-up care to nonhospitalised patients is recommended . RELEVANCE TO CLINICAL PRACTICE Having the ability to develop caring systems based on the nursing theories is a prerequisite to st and ard nursing practice . Identifying patients ' educational needs is a fundamental prerequisite to patient education . Our findings revealed that the supportive educational intervention developed based on the Orem 's self-care theory can help health care providers identify and fulfil patients ' self-care needs AIMS To investigate the long-term benefits of a six-week comprehensive cardiac rehabilitation programme on physical activity , psychological well-being and quality of life in patients with coronary heart disease . BACKGROUND Cardiac rehabilitation ( CR ) in short term improves exercise capacity and quality of life in patients with cardiac disease . However , the long-term benefits of CR are inconclusive . DESIGN A prospect i ve CR programme with repeated measures follow-up over 12 months . METHODS A six-week outpatient cardiac rehabilitation programme  was conducted including 147 patients with coronary heart disease . Patients completed the  physical activity energy expenditure ( seven-day recall activity ) , MacNew Heart Disease Health-Related Quality of Life ( MacNew ) and Hospital Anxiety and Depression scale ( HADs ) at baseline , six weeks , six and 12 months . RESULTS One hundred and five ( 71 % ) patients ( 76 male ) mean age of 61.8 ( SD 9.7 ) completed the four-measurement points . Analysis of variance revealed that total energy expenditure ( F ( 2 , 231 ) = 131 , p < 0.001 ) , HADs ( F ( 2 , 237 ) = 19.3 , p < 0.001 ) , depression score ( F ( 2 , 235 ) = 21.06 , p < 0.001 ) , anxiety score ( F ( 2,237 ) = 17.02 , p < 0.001 ) and MacNew ( F ( 2 , 197 ) = 77.02 , p < 0.001 ) were all statistically significant over time . Bonferroni pairwise follow-up confirmed significant positive differences ( p < 0.05 ) between baseline values and all subsequent measures over time . Depression was independently explained in 22 % of the variance in quality of life at 6 or 12 months . The energy expenditure was significantly higher for men compared to women ( F ( 1 , 103 ) = 31 , p < 0.001 ) . CONCLUSION A six-week cardiac rehabilitation programme is beneficial in improving quality of life , physical activity status , anxiety and depression . These benefits were maintained at 12 months . Elevated levels of depression were associated with impaired quality of life . RELEVANCE TO CLINICAL PRACTICE All relevant health care staff should be aware of the benefits of CR and routinely refer and encourage patients with cardiac disease to attend a cardiac rehabilitation programme . Depression and anxiety intervention strategies should be incorporated in cardiac rehabilitation programmes 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 For this study a r and omized clinical trial was design ed to test the effects of an early home recovery information intervention on physical functioning , psychological distress , and symptom frequency 1 month following coronary artery bypass graft surgery ( CABG ) . Recovery outcomes were compared between two groups : those receiving an audiotape of information on expected physical sensations and their management ( Cardiac Home Information Program [ CHIP ] ) in addition to the usual care , and those receiving the usual cardiac discharge information protocol .  A nonprobability sample of 180 patients ( 84 women and 96 men ; mean age = 62 years ) was equally distributed between the two study groups . When controlling for age , comorbidity , and cardiac functional status , the results showed positive effects on physical functioning in women and psychological distress , vigor and fatigue in men . Consistent with other studies , women had worse physical functioning and more symptom frequency than men . These findings indicate that the CHIP intervention is an effective method to prepare CABG patients for home recovery OBJECTIVE The purpose of this study was to determine the effectiveness of an information and support telephone intervention for reducing anxiety in patients who have undergone coronary artery bypass graft surgery and their partners . DESIGN The study is a r and omized controlled trial . Intervention began at discharge ; 6 telephone calls were made to patients and partners over 7 weeks . Primary outcome was Beck Anxiety Inventory measured at baseline in hospital , at home on day 3 , week 4 , and week 8 . SAMPLE The subjects were 131 patients who have undergone elective coronary artery bypass graft surgery and their partners . RESULTS Patients ' anxiety was moderate to severe the day before discharge . It was significantly lower in the treatment group than in the control group at day 2 at home . Partners always had lower anxiety than patients . A more sustained decrease in anxiety in the partner treatment group was found at both day 2 and week 4 . CONCLUSION Intervention effect is in the early period after discharge-- the time most affected by reduced lengths of stay The purpose of this trial was to determine the effectiveness of advanced practice nursing support on cardiac surgery patients ’ during the first 5 weeks following hospital discharge . Patients ( N = 200 ) were r and omly allocated to two groups : ( a ) an intervention group who received telephone calls from an advanced practice nurse ( APN ) familiar with their clinical condition and care needs , twice during the first week following discharge then weekly thereafter for 4 weeks , and ( b ) a usual care group . Measures of health-related quality of life ( HRQL ) , symptom distress , satisfaction with recovery care , and unexpected health care contacts were obtained at 5 weeks following discharge . There were no significant group differences in HRQL , unexpected contacts with the health care system , or symptom distress . The provision of APN support via telephone followup after cardiac surgery is feasible . However , further r and omized trials of single and multicomponent APN interventions are needed to prove effectiveness OBJECTIVE The objective of this study was to evaluate the effects of a home-based intervention program ( HBIP ) on anxiety and depression 6 months after coronary artery bypass grafting ( CABG ) .  METHODS In a prospect i ve r and omized controlled trial , 203 elective CABG patients were included . An HBIP structured for respondents in the intervention group was performed 2 and 4 weeks after surgery . Anxiety and depression symptoms were measured by the Hospital Anxiety and Depression Scale ( HADS ) in both patient groups before surgery , 6 weeks after surgery , and 6 months after surgery . RESULTS A total of 185 patients completed the study : 93 patients in the intervention group and 92 patients in the control group . On 6-week and 6-month follow-ups , significant improvements in anxiety and depression symptoms were found in both groups . These improvements did not differ significantly between the groups . However , in a predefined subgroup of patients with anxiety and /or depression symptoms at baseline ( n=65 ) , improvement was significantly larger in the intervention group ( n=29 ) than in the control group ( n=36 ) after 6 months ( P<.05 ) . CONCLUSIONS Patients experiencing high levels of psychological distress before CABG surgery benefited from a structured informational and psychological HBIP . Implementation of psychological screens of patients scheduled for CABG might serve to identify patients experiencing anxiety and /or depression . These patients could then be targeted to receive individualized HBIP HeartCare is an Internet-based information and support service for patients recovering at home from coronary artery bypass graft ( CABG ) surgery . The system is design ed to meet the nursing challenges in health information to support needs of CABG patients .  HeartCare ( a ) provides information and support , tailored to patients ' individual and changing recovery needs during CABG recovery , ( b ) makes recovery information more accessible for timely use by patients , and ( c ) extends the scope of nursing services to CABG patients from hospital through home . An ongoing r and omized controlled study is underway to evaluate the clinical outcomes of patients ' use of the HeartCare system  and to examine its acceptance as a usable re source for postCABG patients who have limited previous computer experience BACKGROUND Approximately 30 % of patients undergoing coronary artery bypass graft ( CABG ) procedures have diabetes and , as such , are at increased risk for postoperative complications and a lengthy recovery . OBJECTIVE To test the feasibility of an in-home early recovery management intervention to improve physical and psychosocial functioning in the diabetic CABG population . METHODS This pilot study was a 2-group , r and omized , experimental study . The 6-week in-home early recovery intervention was delivered by way of a device called the Health Buddy ( Health Hero Network , Redwood City , CA ) . Subjects were 49 diabetic patients who had undergone a first-time CABG procedure .  RESULTS Although no statistical differences between groups were found , descriptively , the intervention group 's baseline means on Medical Outcomes Study Short Form-36 subscales measuring physical functioning were lower but improved to levels comparable with that of the control group . Improvements in psychosocial functioning were comparable between the 2 groups . CONCLUSION This in-home telehealth intervention may have promise for improving functioning outcomes in high-risk CABG patients with diabetes . However , weaknesses of the intervention and the need for a more focused , directive intervention were identified AIM The aim of the study was to test the effect of an audiotape giving concrete objective information and strategies to reduce symptoms , psychological distress and enhance physical functioning in patients having coronary artery bypass grafts . BACKGROUND The period following hospital discharge is stressful for patients having coronary artery bypass grafts . Evident-based interventions are needed to improve outcomes in Thai population s following coronary artery bypass graft surgery . METHODS A r and omized controlled trial was conducted during 2004 - 2005 . A sample of 120 Thai patients having coronary artery bypass grafts was r and omly assigned to an intervention group or a control group . The intervention group was given an information audiotape the day prior to hospital discharge , and encouraged to listen to it as many times as necessary . Participants were interviewed using vali date d instruments predischarge and at 2 weeks and 4 weeks after discharge . FINDINGS Participants in the intervention group had statistically significantly fewer symptoms of shoulder , back or neck pain and lack of appetite , and increased physical activity after discharge , compared to the control group . This effect remained statistically significant after controlling for age , gender , co-morbidity and presurgical cardiac functional status . However , no statistically significant difference in psychological distress was observed . CONCLUSION Nurses can use an audiotape containing preparatory information to improve outcomes for patients having coronary artery bypass grafts during the few weeks after discharge from hospital . Further studies are recommended to improve its effect on psychological distress The purpose of this study was to investigate the impact of a supportive-educative telephone program on the levels of knowledge and anxiety of patients undergoing coronary artery bypass graft surgery during the first 6 weeks after hospital discharge . With a posttest-only control group design , the first 74 patients scheduled , between September 1986 and February 1987 , for coronary artery bypass graft surgery in a large , western Canadian teaching hospital were r and omly assigned to either an experimental or a control group . The effect of the intervention , which was implemented by a cardiac rehabilitation nurse specialist , was assessed by a knowledge test and a state anxiety inventory . Data were collected without knowledge of the participants ' group assignment . As hypothesized , data analysis with independent t tests revealed a statistically significant ( p less than 0.05 ) difference between the knowledge level of the experimental and the control group in the areas of coronary artery disease , diet , medications , physical activity restrictions , exercise , and rest . A statistically significant difference between the state anxiety level of the experimental and the control group was also evident , as was a statistically significant inverse relationship between participants ' knowledge and anxiety levels . From these findings , several implication s and recommendations for nursing practice and research have been generated This article presents considerations for the design and testing of electronic interventions to improve recovery outcomes in cardiac patients . A brief description of the design and testing of 2 telehealth interventions for cardiac patients is provided : HeartCare and E-CHANGE . The HeartCare project was a r and omized trial of a home support program for patients after coronary artery bypass graft surgery .  E-CHANGE is an Internet-based home support program design ed to increase lifestyle exercise after a cardiac event . Lessons learned from these 2 projects regarding design considerations , system use , effectiveness , and research challenges are discussed . Methods to promote the preservation of nursing values in electronic systems are described , as well nursing roles in the use of computer-assisted care Background : The ‘ Fit For Surgery ’ programme was based on previous studies suggesting improvement in risk factors contributing to coronary disease while patients wait for cardiac surgery . Aim : To evaluate our nurse-led programme in a r and omised controlled trial with 188 patients . Methods : Patients listed for coronary artery bypass surgery with at least one poorly controlled risk factor were r and omised to st and ard care or the intervention which provided lifestyle counselling and preparation for surgery at monthly intervals . Primary outcome measurements were anxiety , blood pressure , cholesterol , length of stay and body mass index . Costs of the intervention were also collected . Results : For both groups blood pressure and total cholesterol improved ( Blood pressure mm Hg ( Control − 9.11 ( CI − 4.89 , − 13.33 ) ; Intervention − 13.02 ( CI − 8.76 , − U17.29 ) both p < 0.01 ) ; total cholesterol ( Control − 0.20 ( CI − 0.03 , − 0.37 ) p = 0.02 , Intervention − 0.18 ( CI − 0.02 , − 0.34 ) p = 0.03 ) . However there were no significant differences between the groups . Cost minimization analysis showed that the total costs were less in the intervention group due to fewer admissions ( total costs £ 10,754 ( 3746 ) v £ 13,047 ( 5835 ) , CI − 3743 , − 843 ; p = 0.002 ) . Conclusions : The nurse-led programme did not appear to reduce risk factors prior to coronary artery bypass surgery . However , the intervention appears to reduce overall healthcare utilization Common concerns with the traditional protocol ( TP ) for cardiac rehabilitation include suboptimal program participation , poor facilitation of independent exercise , the use of costly continuous electrocardiographic ( ECG ) monitoring , and lack of insurance reimbursement . To address these concerns , a reduced cost-modified protocol ( MP ) was developed to promote independent exercise . Eighty low- to moderate-risk cardiac patients were r and omized to a TP ( n = 42 ) or a MP ( n = 38 ) and were compared over 6 months on program participation , exercise adherence , cardiovascular outcomes , and program costs . During month 1 , patients followed identical regimens , including 3 ECG-monitored exercise sessions/week , with encouragement to achieve > /=5 thirty-minute sessions/week . In week 5 , the TP continued with a facility-based regimen including 3 exercise sessions/week for 6 months and used ECG monitoring the initial 3 months . The MP discontinued ECG monitoring in week 5 and were gradually weaned to an off-site exercise regimen that was complemented with educational support meetings and telephone follow-up . Compared with TP patients , MP patients had higher rates of off-site exercise over 6 months ( p = 0.05 ) , and total exercise ( on site + off site ) during the final 3 months ( p = 0.03 ) . Also , MP patients were less likely to drop out ( p = 0.05 ) . Both protocol s promoted comparable improvements in maximal oxygen uptake ( p < 0.05 ) , blood lipids ( p < 0.001 ) , and hemodynamic measurements ( p < 0.002 ) . The MP cost $ 738 less/patient than the TP and required 30 % less staff ( full-time equivalents ) . These results suggest that a reduced cost MP was as effective as an established TP in improving physiologic outcomes while demonstrating higher rates of exercise adherence and program participation . Thus , the MP or a similar protocol has applicability to hospitals with large capitated or managed care population s to provide cost-effective cardiovascular risk reduction to patients Background and objective The educational aspect of oral anticoagulant treatment is considered a possible cause of variability in anticoagulation levels . The aim of this prospect i ve study was to investigate whether the time spent in the therapeutic range ( TSTR ) by patients taking oral anticoagulants  could be improved by two different , consecutive educational approaches on the crucial aspects of oral anticoagulant therapy . Design and methods Between May and June 2004 , vali date d interviews were conducted with 240 patients ( 128 male and 112 female , mean age 50 ± 12 years ) enrolled in the study . Three months later , the patients were r and omly allocated to three groups . A course that focused on the questions in the interview was followed by the first group ( n = 80 ) ; a brochure containing the correct answers to questions was given to the second ( n = 81 ) ; nothing was provided for the third ( n = 79 ) . Results A significant difference was found in the TSTR between the quarters preceding and following the interview . Mean TSTR increase was 13 % . Patients that were r and omly selected to attend the educational course , read a brochure or do nothing showed similar TSTR percentages in the quarter following the interview . A good control of the anticoagulant therapy ( TSTR > 70 % ) was maintained , with no significant variation during the following three-quarters . Interpretation and conclusions A two-step educational approach for patients on long-term oral anticoagulation does not improve TSTR percentages in the short term BACKGROUND Coronary artery bypass graft ( CABG ) surgery is performed more frequently in individuals who are older and sicker than in previous years . Increased patient acuity and reduced hospital length of stays leave individuals ill prepared for their recovery . OBJECTIVES To test the feasibility of a peer support program and determine indicators of the effects of peer support on recovery outcomes of individuals following CABG surgery . METHODS AND RESULTS A pre-post test pilot r and omized clinical trial design enrolled men and women undergoing first-time nonemergency CABG surgery at a single site in Ontario . Patients were r and omly assigned to either usual care or peer support . Patients allocated to usual care ( n=50 ) received st and ard preoperative and postoperative education . Patients in the  peer support group  ( n=45 ) received individualized education and support via telephone from trained cardiac surgery peer volunteers for eight weeks following hospital discharge . Most ( 93 % ) peer volunteers believed they were prepared for their role , with 98 % of peer volunteers initiating calls within 72 h of the patient 's discharge . Peer volunteers made an average of 12 calls , less than 30 min in duration over the eight-week recovery period . Patients were satisfied with their peer support ( n=45 , 98 % ) . The intervention group reported statistical trends toward improved physical function ( physical component score ) ( t [89]=-1.6 ; P=0.12 ) role function ( t [93]=-1.9 ; P=0.06 ) , less pain ( t [93]=1.30 ; P=0.20 ) and improved cardiac rehabilitation enrollment ( chi2=2.50 , P=0.11 ) . CONCLUSIONS These preliminary results suggest that peer support may improve recovery outcomes following CABG . Data from the present pilot trial also indicate that a home-based peer support intervention is feasible and an adequately powered trial should be conducted Two thous and patients undergoing coronary artery bypass grafting with cardiopulmonary bypass  were prospect ively studied to compare the influence of age on the incidence of neurologic , cardiac , and other complications . Postoperative neurologic events were found in 56 ( 2.8 % ) patients , with an incidence in patients > or = 75 years ( 8.9 % ) more than twice that of patients 65 to 74 ( 3.6 % ) and nine times larger than in patients < 65 ( 0.9 % ) . Cardiac complications did not differ between age groups except for low cardiac output state , which occurred 1.7 times more frequently in patients > or = 75 years compared with those < 65 . Patients with postoperative neurologic events  had a ninefold increase in mortality--35.7 % versus 4.0 % . Logistic regression analysis demonstrate the most important predictors of a postoperative neurologic event to be age , preoperative neurologic abnormality , recent myocardial infa rct ion , and duration of cardiopulmonary bypass . The risk of neurologic complications increases disproportionately to the risk of cardiac complications in the elderly undergoing coronary artery bypass grafting with cardiopulmonary bypass .  Despite neurologic improvement ( 32 of 56 patients ) , a postoperative neurologic event was second only to low cardiac output state as the postoperative complication most highly associated with in-hospital death . These results are important for decisions regarding selection of c and i date s for coronary artery bypass grafting and for prediction of surgical outcome In a trial to evaluate the effectiveness of a nurse-directed intervention design ed to help patients decrease dietary intake of fat , quit or decrease smoking , and increase exercise , 138 women who underwent coronary artery bypass surgery were r and omized to receive special intervention ( SI ) or usual care ( UC ) . The SI group received a behavioral program based on self-efficacy theory in the home 2 weeks after discharge with regular follow-up . The UC group received routine medical care .  Risk factors and lifestyle behaviors were measured at baseline and 1 year after surgery in 116 ( 84 % ) women ( SI = 59 , UC = 57 ) . The SI group decreased their total fat intake from a mean of 38 % of calories at baseline to 35 % at 1 year , while the UC group increased it from 36 % to 38 % . The prevalence of smoking decreased from 24 % at baseline to 8 % at 1 year in the SI group and from 19 % to 14 % in the UC group . At follow-up , the quit rate in those smoking at baseline was 64 % in the SI group , with no new smokers , and 55 % in the UC group , with three new smokers . Both groups reported improvement in exercise , with the proportion of women reporting participation in some form of regular exercise slightly higher in the SI group than in the UC group , 54 % and 51 % , respectively BACKGROUND Depression is commonly reported as a consequence of  coronary artery bypass grafting surgery .  It is the most important barrier to proper treatment of cardiac patients , causing failure in accepting the condition , decreasing the motivation in following the therapeutic recommendations , and negatively affecting the patients ' function and quality of life . OBJECTIVE ( S ) The objective of this study was to investigate the effects of a PRECEDE-based educational program on depression , general health , and quality of life in coronary artery bypass grafting surgery patients . METHODS The experimental study included 54 post-bypass surgery patients in Isfahan Cardiovascular Research Center . The patients were r and omly assigned to intervention and comparison groups ( 27 patients in each ) . The data were collected using four question naires ( Cardiac Depression Scale , General Health Question naire-12 , SF-36 , and a PRCEDE-based question naire to measure predisposing , reinforcing , enabling factors , and self-help behaviors ) . All subjects were pre-tested . The intervention , consisting of nine educational sessions per week ( 60 - 90min each ) was implemented . The patients were followed for 2 months post-intervention and post-tested at the end of the second month . RESULTS Following the educational intervention , the mean scores of predisposing factors , enabling factors , reinforcing factors and self-helping behaviors were significantly increased in the intervention group , compared to the comparison group ( p<0.001 ) . The mean score for depression in the comparison group ( 104.5±30.4 ) and intervention group ( 112.8±21.9 ) decreased significantly following educational intervention , but the change was more pronounced in the intervention group compared with the control group ( 66.2±22 vs. 89.2±27.8 ) . The difference between the two groups on the basis of general health was statistically significant ( p<0.0001 ) . Improvements in quality of life on the basis of physical function ( p<0.04 ) , role limitations result ing from emotional status ( p<0.01 ) , and mental health ( p<0.04 ) were statistically significant . CONCLUSION The findings of the study confirmed the effectiveness of an educational program based on the PRECEDE Model on decreasing depression level , improving general health , and increasing quality of life in coronary artery bypass grafting surgery patients Shortened hospitalizations following cardiac surgery necessitate re-evaluation of how pertinent information for self-care management and reduction of coronary artery disease risk factors can be incorporated into an effective inpatient cardiac patient teaching program . This study investigated the effect of three different teaching approaches ( i.e. , an inpatient teaching program , a postdischarge telephone follow-up program , and a postdischarge group teaching program ) among 90 patients who had undergone coronary artery bypass graft surgery . Teaching outcomes were evaluated in this study by use of the Heart Disease Management Question naire and Cardiac Surgical Patient Teaching Satisfaction Inventory . Analyses of the data revealed similar patient teaching outcomes regardless of the type of teaching intervention the participant received . Findings supported the effectiveness of the inpatient teaching protocol which focused on " survival skills " for self-care management postdischarge . The findings are important in the re design of teaching programs which are efficient yet meaningful to the patient within today 's health care environment . Additional findings indicated that patients who had longer  lengths of stay and those with more vessels bypassed were the least satisfied with their teaching . Further implication s for nurses involved in patient teaching are discussed Objective : To investigate the long-term effect of exp and ed cardiac rehabilitation on a composite end-point , consisting of cardiovascular death , myocardial infa rct ion or readmission for cardiovascular disease , in patients with coronary artery disease . Design : Single-centre prospect i ve r and omized controlled trial . Setting : University hospital . Subjects : Two hundred and twenty-four patients with acute myocardial infa rct ion or undergoing coronary artery by-pass grafting . Intervention : Patients were r and omized to exp and ed cardiac rehabilitation ( a one-year stress management programme , increased physical training , staying at a ‘ patient hotel ’ for five days after the event , and cooking sessions ) , or to st and ard cardiac rehabilitation . Main measures : Data on cardiovascular death , myocardial infa rct ion , readmission for cardiovascular disease and days at hospital for cardiovascular reasons were obtained from national registries of the Swedish National Board of Health and Welfare . Results : The primary end-point occurred in 121 patients altogether ( 54 % ) . The number of cardiovascular events were reduced in the exp and ed rehabilitation group compared with the st and ard cardiac rehabilitation ( 53 patients ( 47.7 % ) versus 68 patients ( 60.2 % ) ; hazard ratio 0.69 ; P = 0.049 ) . This was mainly because of a reduction of myocardial infa rct ions in the exp and ed rehabilitation group . During the five years 12 patients ( 10.8 % ) versus 23 patients ( 20.3 % ) ; hazard ratio 0.47 ; P = 0.047 had a myocardial infa rct ion . Days at hospital for cardiovascular reasons were significantly reduced in patients who received exp and ed cardiac rehabilitation ( median 6 days ) compared with st and ard cardiac rehabilitation ( median 10 days ; P = 0.02 ) . Conclusion : Exp and ed cardiac rehabilitation after acute myocardial infa rct ion or coronary artery bypass grafting reduces cardiovascular morbidity and days at hospital for cardiovascular reasons Coronary  artery bypass ( CAB ) patients are older increasingly more often than before . Effectiveness of cardiac rehabilitation among the elderly is not yet adequately known about . The purpose was to describe short-term ( 3-month ) , intermediate ( 6-month ) , and long-term ( 12-month ) effects of health counseling , guidance , and adjustment education in groups on health , health behaviors , and functional abilities among older CAB patients . The study population was r and omized to an intervention group ( IG=49 ) and a control group ( CG=68 ) . Prior to CAB , intervention included one guidance and counseling group session and four sessions within 12 months following CAB . Intervention had positive effects on exercise activities , use of alcohol , and functional abilities among all participants , and on frequency of eating visible fat , fresh greens and vegetables among men . The intervention was effective with some exercise activities and functional abilities persisting for at least 1 year following CAB . Similar interventions may be arranged for older people . Health care professionals need to guide and encourage older people in their efforts to participate in them OBJECTIVE The purpose of this study is to determine the impact of a home communication intervention ( HCI ) for ischemic heart failure Coronary Artery Bypass Graft ( CABG ) patients > /= 65 years of age on self-efficacy , coronary artery disease risk factor modification and functioning posthospitalization . DESIGN A r and omized clinical trial with repeated measures was used . SAMPLE A sub sample of ischemic heart failure CABG surgery patients ( n = 35 ) was drawn from the parent study of 180 CABG patients . RESULTS HCI participants ( n = 18 ) had significantly higher adjusted mean self-efficacy scores [ F(1 , 29 ) = 6.40 , P < .05 ] and adjusted mean levels of functioning ( physical , general health , mental , and vitality functioning ) compared with the routine care group ( n = 17 ) , using repeated measures analysis of covariance with baseline scores as covariates . There were also significant effects of time on bodily pain and role emotional functioning . Significantly higher exercise adherence ( t = 3.09 , P < .01 ) and lower reported stress ( t = 3.77 , P < .01 ) at 3 months after surgery was reported by HCI subjects . CONCLUSIONS Data from this pilot study can be used to strengthen the HCI intervention with more tailored strategies for vulnerable subgroups of CABG patients BACKGROUND . Comprehensive preventive education for heart patients is effective in reducing cardiac events . However , very dem and ing counselling protocol s can not easily be implemented as an integral part of clinical practice in hospitals . AIM . To evaluate whether recurrent preventive group education for coronary artery bypass grafting patients affects the resistance of LDL against oxidation and the classical risk factors for coronary heart disease . METHODS . A prospect i ve , controlled study with one-year follow-up was carried out in Southern Finl and . Coronary artery bypass patients were allocated late ( S 18 months ) after the operation in the intervention and control groups . RESULTS . Seventy two patients ( 65 men and 7 women ) completed the study . Twelve-hour group education on healthy life-style had a significant ( 25 % , P = 0.01 ) but transient positive effect on the resistance of LDL against oxidation . There was a trend towards increased physical activity in the intervention group . The impact of education on patients ' weight was also more consistent ( 1.2 kg at 12 months , P < 0.05 ) , whereas long-term effects on fibrinogen and serum lipids were small . CONCLUSIONS . Repeated group education applied as an economically feasible part of specialist care had only small positive effects on patients ' risk factors . There was a significant , but transient , increase in the resistance of LDL against oxidation . However , effective lipid lowering drug treatment is indicated for most coronary artery bypass patients rather than repeated health education alone AIMS AND OBJECTIVES The aim of this study was to determine how discharge training and counselling provided to patients , who had undergone coronary artery bypass graft ( CABG ) surgery , had effects on patients ' self-care ability and on the problems encountered after discharge . The objectives were to help patients develop self-care behaviour to deal more comfortably with the problems caused by the disease and , hopefully , to reduce the number of problems they may encounter . BACKGROUND CABG surgery patients needing to manage various aspects of their self-care at home often find these tasks very difficult to carry out effectively . Discharge training and counselling services help patients undergoing CABG to develop self-care behaviours . DESIGN The study was prospect i ve and quasi-experimental . METHODS The intervention and control groups consisted of 57 patients who were given discharge training and counselling by a research er and 52 patients who were given routines by a nurse , respectively . The intervention group began receiving discharge training and counselling on the day of hospitalization . These were provided according to their individual knowledge needs and patients were given a booklet developed for training purpose s. Data were collected by research er using the Personal Information Form , the Self-Care Agency Scale . RESULTS It was found that the intervention group had a higher mean self-care score than the control group and experienced fewer problems following discharge compared with patients in the control group . CONCLUSION The discharge training and counselling services given to patients in the intervention group had a positive impact on the self-care ability of these patients and on alleviating the problems they encountered . RELEVANCE TO CLINICAL PRACTICE As discharge training and counselling services had a positive impact on the self-care and alleviation of the problems that patients encounter after being discharged , we recommend application of these services and the usage of the training booklet for CABG patients OBJECTIVE To evaluate the effectiveness of a nurse led shared care programme to improve coronary heart disease risk factor levels and general health status and to reduce anxiety and depression in patients awaiting coronary artery bypass grafting ( CABG ) . DESIGN R and omised controlled trial . SETTING Community , January 1997 to March 1998 . STUDY GROUPS 98 ( 75 male ) consecutive patients were recruited to the study within one month of joining the waiting list for elective CABG at Glasgow Royal Infirmary University NHS Trust . Patients were r and omly assigned to  usual care ( control ; n = 49 ) or a  nurse led intervention programme  ( n = 49 ) . INTERVENTION A shared care programme consisting of health education and motivational interviews , according to individual need , was carried out monthly . Care was provided in the patients ' own homes by the community based cardiac liaison nurse alternating with the general practice nurse at the practice clinic . OUTCOME MEASURES Smoking status , obesity , physical activity , anxiety and depression , general health status , and proportion of patients exceeding target values for blood pressure , plasma cholesterol , and alcohol intake . RESULTS Compared with patients who received usual care , those participating in the nurse led programme were more likely to stop smoking ( 25 % v 2 % , p = 0.001 ) and to reduce obesity ( body mass index > 30 kg/m2 ) ( 16.3 % v 8.1 % , p = 0.01 ) . Target systolic blood pressure improved by 19.8 % compared with a 10.7 % decrease in the control group ( p = 0.001 ) and target diastolic blood pressure improved by 21.5 % compared with 10.2 % in the control group ( p = 0.000 ) . However , there was no significant difference between groups in the proportion of patients with cholesterol concentrations exceeding target values . There was a significant improvement in general health status scores across all eight domains of the 36 item short form health survey with changes in difference in mean scores between the groups ranging from 8.1 ( p = 0.005 ) to 36.1 ( p < 0.000 ) . Levels of anxiety and depression improved ( p < 0.000 ) and there was improvement in time spent being physically active ( p < 0.000 ) . CONCLUSIONS This nurse led shared care intervention was shown to be effective for improving care for patients on the waiting list for CABG This experimental study examined the effectiveness of a psychoeducational intervention delivered over 12 weeks . The sample was comprised of 38 coronary artery bypass graft ( CABG ) surgery patient-family member caregiver dyads who completed all six data collection points . Experimental and control groups did not differ in emotional health , functional health status , or satisfaction . Differences in the number of self-reported complications/symptoms were not in the predicted direction . Improvement occurred in clinical , functional , and emotional outcomes ; however , several symptoms , such as fatigue and pain , persisted . Family caregivers reported more depressive symptoms than patients preoperatively and at later stages of recovery . Implication s include the need for instruction about the recovery trajectory and adequate preparation and support of home health nurses and family caregivers BACKGROUND & OBJECTIVE Evidence s suggest that relaxation therapy may improve psychological outcomes in heart patients . We evaluated the effect of progressive muscular relaxation ( PMR ) training in decreasing anxiety and improving quality of life among anxious patients after coronary artery bypass graft surgery ( CABG ) . METHODS This study was an open uncontrolled trial . The sample included 110 anxious patients referred to the cardiac rehabilitation clinic of Tehran Heart Center , Tehran , Iran , during six weeks after coronary artery bypass graft ( CABG ) . Patients were allocated to receive both exercise training and lifestyle education plus relaxation therapy ( relaxation group ; n=55 ) or only exercise training beside lifestyle education ( control group or the recipient of usual care group ; n=55 ) . Duration of the relaxation therapy was 6 wk and in the case of usual care was 8 wk . Both the groups were followed up one month after completion of intervention . Anxiety and quality of life in the two treatment groups were compared . RESULTS There were no significant differences in overall QOL , state anxiety and trait anxiety scores between the two groups before intervention . Significant reductions in state anxiety ( P<0.01 ) and trait anxiety ( P<0.01 ) levels were observed in relaxation group after intervention compared to control group . Women had high state anxiety and a low quality of life than men in the two groups before intervention . After intervention , there was no difference between men and women in the relaxation group . INTERPRETATION & CONCLUSION Our findings show that progressive muscular relaxation training may be an effective therapy for improving psychological health and quality of life in anxious heart patients Tobacco smoking is a major risk factor for cardiovascular disease [ 1 ] . Smokers who quit reduce their coronary heart disease morbidity and mortality rates , even after the onset of clinical disease . Smokers who quit after a myocardial infa rct ion have lower reinfa rct ion rates and longer survival than do those who continue to smoke [ 2 ] . The relation between smoking and the outcome of coronary artery bypass graft surgery is less well studied , but in one study , smokers who quit after surgery had better survival , fewer attacks of angina , and fewer hospitalizations during a 10-year period [ 3 , 4 ] . Pathologic and angiographic studies show less late saphenous vein graft occlusion in smokers who quit after surgery than in those who do not [ 5 , 6 ] . Neither the pattern nor predictors of smoking cessation after coronary artery bypass graft surgery have been well studied . The operation may induce smoking cessation , because myocardial infa rct ion and newly diagnosed coronary artery disease do so [ 2 , 7 - 9 ] . Approximately one third of smokers quit smoking after having a myocardial infa rct ion [ 2 , 9 , 10 ] . Patients scheduled for coronary bypass surgery  , like patients who have myocardial infa rct ion , face a potentially life-threatening event related to coronary heart disease , one requiring hospitalization for at least 1 week . However , coronary bypass surgery is often elective , whereas myocardial infa rct ion may be an unexpected complication of an undiagnosed condition . Consequently , patients may be less motivated to stop smoking after bypass surgery than they are after myocardial infa rct ion . In a r and omized trial of coronary artery bypass surgery , 25 % of smokers assigned to surgery stopped smoking in the year after the operation , and smoking rates remained constant for the next 5 years [ 11 ] . Two newer studies reported higher cessation rates ( 31 % and 55 % ) [ 12 , 13 ] . None of these studies vali date d self-reported smoking status at follow-up or identified factors associated with nonsmoking . Even less is known about the success of smoking interventions in patients having coronary bypass surgery . In-hospital intervention boosts the cessation rate after myocardial infa rct ion [ 10 , 14 ] , but whether it will do so after bypass surgery is unknown . To determine this , we developed a smoking cessation program for in patients recovering from coronary artery bypass surgery and tested its effectiveness in a r and omized , controlled trial . We chose this approach because patients who undergo coronary bypass surgery  spend a median of 11 days in the hospital after surgery [ 15 ] . During this time , they are not permitted to smoke , can be easily reached by an intervention team , and may be highly motivated to quit . We reasoned that we could take advantage of this period of enforced nonsmoking to teach smokers the skills to remain abstinent after discharge . We also tried to identify factors associated with sustained nonsmoking to guide future intervention efforts . Methods Recruitment and R and omization This trial was conducted in the postoperative cardiac surgery unit at Massachusetts General Hospital . During 1 year ending 1 July 1987 , we review ed the charts of all 672 patients scheduled for coronary artery bypass surgery by six participating surgeons ( 82 % of all such procedures ) . A research nurse recruited patients who met eligibility criteria : those who had smoked at least 1 pack of cigarettes in the past 6 months , lived in eastern Massachusetts or Rhode Isl and , spoke English , and were not too ill to participate . We included both current smokers and recent ( < 6 months ) quitters because of the high relapse rates known to follow smoking cessation . Of 672 patients scheduled for the surgery , 152 ( 23 % ) were current smokers or had quit within 6 months . Of 120 patients meeting eligibility criteria , 93 ( 78 % ) agreed to participate . Reasons for refusals were insufficient time to collect baseline data ( n = 8) , too much stress ( n = 6 ) , no desire to quit ( n = 6 ) , or perceived ability to quit without assistance ( n = 3 ) . Patients were r and omly assigned to control or intervention groups after surgery . Intervention began when the patient was physically able to participate , generally on the fourth day after operation . Four participants were lost before r and omization ( surgery was canceled for 3 and 1 died ) , and 89 patients were r and omly assigned to control or intervention groups . Two patients , one in each group , died before discharge , when outcome was first assessed . This report is based on the 87 patients ( 43 controls , 44 patients receiving the intervention ) who were discharged alive . Intervention The intervention was a smoking cessation and relapse prevention program adapted from the American Lung Association 's In Control program , which teaches cognitive and behavioral smoking cessation techniques [ 16 ] . We used edited portions of the videotape and manual to produce a st and ardized , three-session program delivered by the study nurse to individual patients . Family members were encouraged to attend . Total counseling time was 60 minutes . One week after discharge , the nurse called each participant to offer support and brief counseling . Patients in the control group received usual postoperative care , including brief advice not to smoke as part of a group lecture . In patients were not permitted to smoke by hospital policy . Assessment Patients completed a baseline data form before surgery . It assessed demographic factors ( age , sex , ethnic background , education , and employment status ) , functional status [ 17 ] , smoking history ( pack-years and daily cigarette consumption ) , degree of nicotine addiction [ 18 ] , current symptoms of nicotine withdrawal [ 19 ] , previous attempts to quit smoking ( number of attempts , duration , difficulty , and method ) , level of social support for nonsmoking , percentage of household members and friends who smoke , knowledge and attitudes about smoking and heart disease ( 15 items ) , duration of nonsmoking before surgery , intention to quit after surgery , and confidence in their ability to quit . Charts were review ed for medical history , severity of heart disease ( frequency of angina attacks , number of myocardial infa rct ions , previous bypass surgery or angioplasty , left ventricular function on angiogram , and number of coronary vessels occluded and bypassed ) , and hospital course ( length of stay and occurrence of 12 complications ) . The primary outcome variable was smoking behavior , assessed by self-report and vali date d by saliva cotinine assay [ 20 ] . Smoking status was monitored at hospital discharge and 2 weeks and 2 , 4 , 8 , and 12 months later . It was also assessed in September 1992 , a median of 5.5 years after discharge ( range , 60 to 72 months ) . At 1 and 5.5 years , self-reported nonsmoking was vali date d by saliva cotinine assay [ 20 ] . Sample s were obtained by mail , a method previously shown to accurately identify smokers and nonsmokers [ 21 ] . Individuals who did not provide saliva sample s or whose cotinine concentrations were more than 20 ng/mL were considered smokers [ 22 ] . Death certificate data were review ed to identify patients lost to follow-up . Eighty patients ( 92 % ) were alive 1 year after discharge , and smoking status was determined in all of them . Seventy patients ( 80 % ) were alive at 5.5 years , and smoking status was assessed in 66 ( 94 % ) . More than 90 % of follow-up information was obtained by telephone . If this was not possible , patients were sent a written form . Other variables assessed at follow-up were nicotine withdrawal symptoms , attitudes and beliefs about smoking , confidence in the ability to quit , health status , and functional status . We also monitored co interventions , including attendance at a cardiac rehabilitation or smoking cessation program , interim hospitalization , and use of nicotine gum . ( Transdermal nicotine was not available during the study period . ) Data Analysis Two outcome rates were calculated : continuous nonsmoking ( no smoking since hospital discharge ) and current nonsmoking ( no smoking for the past week ) [ 23 ] . Following st and ard practice , patients lost to follow-up and patients whose reports of nonsmoking were not vali date d biochemically were counted as smokers when calculating cessation rates [ 23 ] . We excluded these patients and repeated the calculations . To identify factors associated with smoking cessation , we compared smokers and nonsmokers 1 and 5.5 years after surgery . To minimize misclassification of smoking status in these analyses , we excluded patients lost to follow-up and nonsmokers whose self-report was not vali date d biochemically . We compared differences in proportions and means between groups using chi-square tests and Student t-tests , respectively . Variables associated with nonsmoking at the P < 0.05 level were entered into backward stepwise , multiple logistic regression models , and odds ratios with 95 % CIs were calculated . Age , sex , and education level were included in all multivariate models . Significance tests were two-tailed . Results Comparison of Groups at Baseline No statistically significant differences were found between control and intervention groups at study entry or during hospitalization ( Table 3 ) . The typical participant was a middle-aged , white man with a high school education who smoked 1.5 packs each day and had a 58 pack-year smoking history . Participants had made an average of 2.5 attempts to quit smoking , but only 14 % had attended a formal program . Although 79 % of patients had been told to abstain from cigarettes before surgery , 48 % smoked in the week before admission and 15 % smoked in the hospital before surgery . In contrast , 38 % abstained from tobacco for more than 1 month before admission and 19 % did not smoke for more than 3 months . As a group , participants knew that smoking contributed to their heart disease and believed that they would benefit from quitting . They were strongly motivated to quit smoking after surgery and expected some difficulty but were confident of success . They felt strong social support for CONTEXT Depressive symptoms commonly follow coronary artery bypass graft ( CABG ) surgery and are associated with less positive clinical outcomes . OBJECTIVE To test the effectiveness of telephone-delivered collaborative care for post-CABG depression  vs usual physician care . DESIGN , SETTING , AND PARTICIPANTS Single-blind effectiveness trial at 7 university-based and community hospitals in or near Pittsburgh , Pennsylvania . Participants were 302 post-CABG patients with depression ( 150 , intervention ; 152 , usual care ) and a comparison group of 151 r and omly sample d post-CABG patients without depression recruited between March 2004 and September 2007 and observed as out patients until June 2008 . INTERVENTION Eight months of telephone-delivered collaborative care provided by nurses working with patients ' primary care physicians and supervised by a psychiatrist and primary care physician from this study . MAIN OUTCOME MEASURES Mental health-related quality of life ( HRQL ) measured by the Short Form-36 Mental Component Summary ( SF-36 MCS ) at 8-month follow-up ; secondary outcome measures included assessment of mood symptoms ( Hamilton Rating Scale for Depression [ HRS-D ] ) , physical HRQL ( SF-36 PCS ) , and functional status ( Duke Activity Status Index [ DASI ] ) ; and hospital readmissions . RESULTS The intervention patients reported greater improvements in mental HRQL ( all P < or = .02 ) ( SF-36 MCS : Delta , 3.2 points ; 95 % confidence interval [ CI ] , 0.5 - 6.0 ) , physical functioning ( DASI : Delta , 4.6 points ; 95 % CI , 1.9 - 7.3 ) , and mood symptoms ( HRS-D : Delta , 3.1 points ; 95 % CI , 1.3 - 4.9 ) ; and were more likely to report a 50 % or greater decline in HRS-D score from baseline ( 50.0 % vs 29.6 % ; number needed to treat , 4.9 [ 95 % CI , 3.2 - 10.4 ] ) than usual care patients ( P < .001 ) . Men with depression were particularly likely to benefit from the intervention ( SF-36 MCS : Delta , 5.7 points ; 95 % CI , 2.2 - 9.2 ; P = .001 ) . However , the mean HRQL and physical functioning of intervention patients did not reach that of the nondepressed comparison group . CONCLUSION Compared with usual care , telephone-delivered collaborative care for treatment of post-CABG depression result ed in improved HRQL , physical functioning , and mood symptoms at 8-month follow-up . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00091962
target: 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
background: 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 .