Morbidity and mortality in patients waiting for coronary artery bypass surgery.
ABSTRACT To describe morbidity and mortality in patients waiting for coronary artery bypass graft (CABG) surgery and to assess determinants for the occurrence of these complications.
A prospective cohort study was carried out in a tertiary referral general teaching hospital. Three hundred and sixty consecutive patients with a priority of routine or urgent who were accepted for CABG or CABG with additional valve surgery were evaluated. Follow-up began from the moment of acceptance until the procedure took place for cardiac death, myocardial infarction and unstable angina requiring hospital admission.
The median (25-75th percentile) waiting time in the two priority groups was 100 (79-119) days for the routine group and 69 (38-91) days for the urgent group. Overall, eight patients died, seven suffered a myocardial infarction, and 33 episodes of unstable angina requiring immediate hospitalization occurred. The majority of events took place during the first 30 days on the waiting list. Unstable angina less than 3 months before acceptance was identified as an independent predictor (hazard ratio 2.5, 95% confidence interval 1.2-5.1) for complications during the wait. The prognostic value of smoking and familial cardiovascular disease was found to vary depending on the priority assigned to the patient.
Complications occur relatively early during the time on the waiting list. If complications in coronary heart disease cannot be predicted more accurately, the only way to diminish the complication rate is drastic reduction of waiting times.
Full-textDOI: · Available from: Jan J Piek, Feb 05, 2014
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ABSTRACT: BACKGROUND: Radiofrequency ablation (RFA) is undertaken as a potentially curative treatment for a variety of heart rhythm disturbances. Previous studies have demonstrated improved quality of life and reduced symptoms after ablation. In many health care environments waiting lists exist for scheduling of procedures. However, the psychological effects of waiting for radiofrequency ablation have not previously been assessed. We hypothesized that waiting for this intervention may be associated with increased psychological morbidity and health care costs. METHODS: Ninety-two patients scheduled for elective RFA completed repeated questionnaires comprising the Medical Outcomes Short Form 36, Hospital Anxiety and Depression Scale, and an in-house questionnaire designed to assess the burden of symptoms related to arrhythmia (arrhythmia-related burden score). Mean scores were generated and compared at time points while waiting, before and after the procedure. Regression analyses were carried out to identify predictors of increased psychological morbidity while waiting and immediately prior to the procedure. Health care costs during the waiting period as a consequence of arrhythmia were quantified. RESULTS: Mean scores for parameters of psychological morbidity worsened during the period of waiting and improved after the procedure. Predictors of adverse effects within the cohort varied according to the time point assessed for each of the measures of psychological morbidity. A conservative estimate of the health care cost incurred while waiting exceeds £181 per patient. CONCLUSIONS: Waiting for radiofrequency ablation appears to be associated with adverse psychological effects and health care costs. These results may support strategies to reduce waiting times and prioritize resource allocation.Pacing and Clinical Electrophysiology 02/2013; 36(6). DOI:10.1111/pace.12099 · 1.25 Impact Factor
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ABSTRACT: This qualitative descriptive study, underpinned by the naturalistic inquiry, explored the lived experiences of individuals awaiting coronary artery bypass grafting in Thailand. Eleven northern Thai individuals volunteered to participate. Data were gathered through in-depth interviews and analyzed using content analysis. Two major themes arose: uncertainty of life and striving to balance well-being. The first of these themes is presented in this paper. Uncertainty of life was recognized as a dynamic emotional state of being unsure or insecure in life, but its occurrence depended on the individual situation; it was described through two subthemes that had a profound effect on the participants: fear of death and fear of disability. Participants' uncertainty of life encompassed being unsure about the risks of dying from illness, both prior to and following the surgery, and surviving the surgery with a disability. These findings provide insight into the experiences of individuals awaiting coronary artery bypass grafting and will assist nurses and other healthcare providers in creating timely programs and appropriate interventions to reduce uncertainty of life while awaiting surgery.Nursing and Health Sciences 06/2013; DOI:10.1111/nhs.12058 · 0.85 Impact Factor
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ABSTRACT: Background: Coronary artery bypass graft surgery improves quality of life and survival rates. However, prolonged waits for this surgery are inevitable in countries having nationalized healthcare systems. Although no significant decline in the waiting times for this surgery has been demonstrated, recent research in psychological experiences of the patients is lacking Objectives: 1) To describe psychological experiences, anxiety and uncertainty, and quality of life in Omani patients awaiting coronary artery bypass graft. 2) To examine the significance of sociodemographics, health characteristics and the waiting time in predicting anxiety and uncertainty. 3) To examine the independent effect of anxiety and uncertainty in predicting quality of life of the patients. Methods: This study used a cross-sectional design. To obtain the required information, two nurses interviewed a convenience sample of hospitalized patients for coronary artery bypass graft (N = 84) between May 2011 and June 2012. Three regression analyses were used to identify significant predictors of anxiety, uncertainty and quality of life. Results: Literate patients and those with infrequent hospital admissions were more likely to experience high levels of anxiety, whereas, patients without myocardial infarction but having hypertension, and those who waited for the surgery 60 days or less were more likely to report greater uncertainty. Exercising regularly, low family monthly income and short duration since diagnosis with coronary artery disease significantly predicted better quality of life Conclusion: Physiological disruptions and concomitant chronic illnesses have significant effects on the psychological experiences and quality of life of the patients.