Determining predictors of delayed recovery and the need for transitional cardiac rehabilitation after cardiac surgery.
To examine the relationship between demographic and clinical characteristics of cardiac surgery patients with postoperative length of stay (PLOS) greater than 7 days and determine the demographic, social, and clinical predictors of the need for transitional cardiac rehabilitation (TCR) after cardiac surgery.
A retrospective review of characteristics, clinical indices, caregiver availability, and patient status (whether living alone) was completed for 304 patients undergoing cardiac surgery over 24 consecutive months. Univariate analyses and multivariable logistic regression models were used to evaluate risk factor characteristics for PLOS greater than 7 days and to predict discharge disposition to TCR or home.
Older patients, those with preoperative comorbidities, and those without a caregiver at home experience delays in functional recovery and discharge and are more likely to need TCR services.
Our findings support the addition of functional recovery and social support risk items to the preoperative cardiac surgery risk assessment.
Available from: Raffaele Griffo
- "Predittori più significativi di re-ospedalizzazione sono: l'età, il sesso femminile, il soprappeso-obesità, la presenza di pregressi eventi cardio-cerebro-vascolari , lo scompenso cardiaco, la BPCO, il diabete, l'insufficienza renale o epatica, la necessità di dimissione " protetta " , una degenza cardiochirurgica >8 gg. A proposito di quest'ultima, un recente lavoro su un'ampia casistica ha evidenziato come la condizione maggiormente associata ad una degenza in cardiochirurgia >7gg sia l'età (OR 9.4 per 65aa e oltre), l'essere stati sottoposti ad un intervento di chirurgia valvolare o sull'aorta e l'assenza di un caregiver (OR 3.9). Tutte correlano fortemente con la probabilità di essere trasferito in una CR degenziale . "
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ABSTRACT: The increasing evidence on the favourable cost/effectiveness impact of the comprehensive cardiac rehabilitation program for the treatment of a wide spectrum of cardiovascular conditions have imposed to healthcare services a major attention on a critical analysis of the results in different clinical indications and delivery organisations. The Regional Health Agency of Liguria, in the occasion of drawing up regional guidelines directed to define the clinical indications and the effectiveness of the cardiac rehabilitation delivery model (in-patients, out-patients and home-based) and its requisites, indications and procedures, has updated the reference guidelines (PLNG and SIGN) with the evidence provided by the more recent literature, focusing its attention on the clinical and, in particular, organizational effectiveness. The document, on the base of these evidences, provides some effective proposals and some organizational advices.
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ABSTRACT: Cardiac rehabilitation is a key component of the comprehensive care of the 79.4 million adults in the United States with one or more forms of cardiovascular disease. Only a fraction of eligible candidates complete cardiac rehabilitation and women are at a significantly higher risk for underutilizing this safe and effective secondary prevention intervention. This article reviews the complex array of barriers to cardiac rehabilitation, with a focus on those factors that are unique to women. The Healthcare Utilization Model is used as a theoretical framework to categorize these barriers into environmental, physician, and patient level categories. These barriers, although challenging for both patients and healthcare professionals, provide opportunities for change. Actionable evidence-based recommendations for healthcare professionals include making changes in health policy, using proven performance improvement methodologies to increase referral and enrollment, using interdisciplinary models of communication, and enhancing cardiac rehabilitation program attributes reflective of women's preferences and needs.
Available from: uu.diva-portal.org
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