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

摘要

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