Abstract 3543: Long-Term Benefits of Cardiac Rehabilitation in Patients With Incomplete Revascularization: 5-Year Follow-up.

There is evidence that cardiac rehabilitation (CR) determines important benefits in patients with coronary artery disease(CAD). However, it is unclear whether CR may improve the outcome of pts with incomplete revascularization (IR) after PTCA/stenting and/or coronary artery bypass surgery (CABG). From 1/1/2002 to 30/11/2004, we prospectively studied 259 patients with CAD who underwent PTCA after a SCA or CABG in 1(10/7%, respectively), 2(20/19%) and 3 major coronary arteries (70/74%). Patients were randomized into 2 homogeneous groups on the basis of the results of cardiopulmonary exercise stress testing(CPET) performed twice one week apart: a group with a positive CPET for inducible ischemia (P, n=129), and a group with a negative CPET (N, n=130). Patients were further randomized into 2 groups. The intervention group(Group CR) received CR combining exercise training (60%peak VO2, 3 times a week for 8 weeks)+ nutrition counseling+ standard medications (65P+65N, 25% women, mean age 56±8 years), while the control group (Group C) had no CR (65P+64N, 25% women, mean age 58±8 years). On entry and at 8 weeks all patients underwent CPET, brachial artery flow-mediated dilation (BA-FMD) and blood chemistry. Group CR-N had more marked improvements in peak VO2 and FMD than CR-P (P<0.001 for both). However, CPET became negative in 22% post PTCA CR-P patients and 28% post CABG CR-P (P<0.001 vs initial). After 8 weeks, group CR was recommended to continue a home program of exercise training with periodic supervision at the hospital’s gym, while group C was not. At 5 years, both peak VO2 and FMD were significantly higher in CR (P<0.01 vs C) with no differences between CR-P and CR-N. Cardiovascular risk profile (CVRP) was significantly improved in CR (P<0.01 vs C). Cardiac events were significantly lower in CR than C : new acute coronary syndrome (P<0.001); new PCI (P<0.0001); new CABG(P<0.001); hospital readmission: (P<0.0001); cardiac death (P<0.05). Multivariate analysis demonstrated that the lower rate of events in CR was not collinear with changes in CVRP. In conclusion, IHD patients with IR take advantage from CR and maintain a higher functional capacity and a better control of CVRP at 5 years. These benefits were associated with a better outcome.

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Do Patients Maintain Proper Long-Term Cardiopulmonary Fitness Levels After Cardiac Rehabilitation? A Retrospective Study Using Medical Records

Annals of Rehabilitation Medicine ◽

10.5535/arm.20123 ◽

2021 ◽

Vol 45 (2) ◽

pp. 150-159

Author(s):

Chul Kim ◽

Hee Eun Choi ◽

Jin Hyuk Jang ◽

Jun Hyeong Song ◽

Byung-Ok Kim

Keyword(s):

Retrospective Study ◽

Exercise Training ◽

Cardiac Rehabilitation ◽

Artery Bypass ◽

Bypass Graft ◽

Hospital Setting ◽

Aerobic Exercise Training ◽

Cardiopulmonary Fitness ◽

Coronary Syndrome

Objective To examine whether patients who participated in a cardiac rehabilitation (CR) program after hospitalization for acute coronary syndrome maintained cardiorespiratory fitness (CRF) in the community.Methods We conducted a retrospective study including 78 patients who underwent percutaneous coronary intervention or coronary artery bypass graft surgery at our hospital’s cardiovascular center and participated in a CR program and a 5-year follow-up evaluation. Patients were divided into a center-based CR (CBCR) group, participating in an electrocardiography-monitored exercise training in a hospital setting, and a home-based CR (HBCR) group, receiving aerobic exercise training and performed self-exercise at home.Results No significant differences were found between groups (p>0.05), except the proportion of non-smokers (CBCR 59.5% vs. HBCR 31.7%; p=0.01). In both groups, the maximal oxygen consumption (VO<sub>2max</sub>) increased significantly during the first 12 weeks of follow-up and remained at a steady state for the first year, but it decreased after the 1-year follow-up. Particularly, VO<sub>2max</sub> at 5 years decreased below the baseline value in the HBCR group. In the low CRF group, the CRF level significantly improved at 12 weeks, peaked at 1 year, and was still significantly different from the baseline value after 5 years. The high CRF group did not show any significant increase over time relative to the baseline value, but most patients in the high CRF group maintained relatively appropriate CRF levels after 5 years.Conclusion Continuous support should be provided to patients to maintain optimal CRF levels after completing a CR program.

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Intravenous glycoprotein IIbIIIa inhibitor bridging for urgent coronary artery bypass graft after acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.3387 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.R.C Ferreira ◽

L.M Baracioli ◽

T Dalcoquio ◽

C.A.K Nakashima ◽

C.D Soffiatti ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Red Blood Cells ◽

Coronary Artery Bypass ◽

Blood Cells ◽

Artery Bypass ◽

Bypass Graft ◽

Control Group ◽

Artery Bypass Graft ◽

Coronary Syndrome

Abstract Background Previous studies have shown the safety of intravenous glycoprotein (GP) IIbIIIa inhibitors used as a bridging after ADP receptor blocker withdrawal in patients with stable coronary artery disease and previous percutaneous coronary interventions (PCI) undergoing cardiac or non-cardiac surgeries. However, there are few data analyzing GP IIbIIIa inhibitor bridging among patients with acute coronary syndromes (ACS) scheduled for coronary artery bypass graft (CABG) during the same hospitalization. Purpose To evaluate the safety of tirofiban bridging after clopidogrel withdraw in post-ACS patients schedule for CABG during the same hospitalization. Methods Fifty-six patients who underwent CABG after tirofiban bridging post-ACS (bridge group - BG) were compared to 56 sex and age-matched controls also submitted to same-hospitalization CABG post-ACS without bridging (control group - CG). All patients received aspirin plus clopidogrel for ACS; clopidogrel was withdrawn 5 to 7 days before CABG and aspirin was maintained during the whole perioperative period. The primary endpoint was chest tube output in the first 24h after CABG (CTO24h). We hypothesized that BG would be non-inferior to CG, with a non-inferiority margin of 25% in excess of CTO24h in the BG compared to the CG, based on prior literature data. Other exploratory analyses were: blood transfusions, number of red blood cells/patient and re-thoracotomy 24h after surgery. A multivariable linear regression model was developed considering CTO24h as dependent variable and adjusted for other eight co-variates, described in the figure. Results From the 112 patients included (75% men; mean age 60.2±9.3 years), in comparison with CG, BG had higher proportion of STEMI (80.0% vs. 28.6%, p<0.01), fibrinolytic utilization (25% vs. 7.1%, p<0.05), PCI in the acute phase (92.9% vs. 0%, p<0.01) and LMCA stenosis (30.4% vs. 7.1% p<0.01). Tirofiban was utilized by clinician discretion due to PCI in the same hospitalization previously to CABG (n=52), previous PCI up to 3 months before index event (n=3) or severe LMCA stenosis (n=1). BG patients received tirofiban for a mean of 4.3±2.1 days and it was withdrawn at a mean of 6.6±4.3 hours before CABG. After adjustments, BG was non-inferior to CG regarding CTO24h (figure) There were no significant differences between BG and CG regarding need for blood transfusion (26.8% vs. 26.8%, p>0.99), mean number of red blood cells/patient (0.3±0.8 vs 0.5±1.2, p=0.35) or re-thoracotomy due to bleeding (5.4% vs 0%, p=0.24). Conclusion Among ACS patients submitted to urgent CABG after clopidogrel withdrawal, tirofiban bridging, compared to no bridging, was not associated with higher risk of bleeding in the first 24 hours after surgery. Our study suggests that tirofiban may be a safe therapy to patients with high risk of thrombotic complication (such as stent thrombosis or re-infarction) after clopidogrel withdraw. Figure 1 Funding Acknowledgement Type of funding source: None

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Planned discharge program effectiveness on cardiac self-efficacy and hope in patients undergoing coronary artery bypass graft surgery: A quasi-experimental study

Proceedings of Singapore Healthcare ◽

10.1177/20101058211064669 ◽

2021 ◽

pp. 201010582110646

Author(s):

Tayebeh Eghbali ◽

Batool Tirgari ◽

Zahra Dehghani ◽

Mansooreh A Forouzi

Keyword(s):

Experimental Study ◽

Coronary Artery ◽

Self Efficacy ◽

Artery Bypass ◽

Bypass Graft ◽

Intervention Group ◽

Control Group ◽

Artery Bypass Graft ◽

Quasi Experimental ◽

Cabg Patients

Background Controlling risk factors and lifestyle modification in coronary artery bypass graft (CABG) patients plays an important role and leads to the empowerment of these patients to take care of themselves. One way to empower these patients is to improve their self-efficacy and hope. This study aimed to investigate the effect of the planned discharge on cardiac self-efficacy and hope of CABG patients. Methods In this quasi-experimental study, the sample consisted of 60 people (30 in the intervention group and 30 in the control group). Data were collected using the Miller Hope Questionnaire and Sullivan Cardiac Self-Efficacy Questionnaire. Data analysis was performed using central indices of mean and standard deviation and Chi-square, t-tests and one-way analysis of variance. The software used for data analysis was SPSS version 19. Results The mean age of participants in the control group was 91/9 ± 86/91 and in the intervention, group was 33/7 ± 7/58. There was no significant difference between the demographic characteristics, heart self-efficacy and hope scores of the participants in the control and intervention groups. After the intervention, there was a meaningful statistical difference between the two groups at discharge time and 1 month afterward in both hope and cardiac heart self-efficacy scores ( p = 0.001, 0.0001). Conclusion In this study, the implementation of the discharge program was effective in increasing the hope and cardiac self-efficacy of CABG patients and the use of the discharge plan is recommended to improve the outcomes of these patients.

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The Effect of Pulmonary Rehabilitation on Respiratory Functions, and the Quality of Life, following Coronary Artery Bypass Grafting: A Randomised Controlled Study

BioMed Research International ◽

10.1155/2021/6811373 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Zümrüt Girgin ◽

Yeliz Ciğerci ◽

Fatıma Yaman

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Pulmonary Rehabilitation ◽

Artery Bypass ◽

Intervention Group ◽

Controlled Study ◽

Control Group ◽

Bypass Grafting ◽

Artery Bypass Grafting

Objective. Examining the effects of a pulmonary rehabilitation (PR) program applied to patients undergoing coronary artery bypass grafting (CABG) surgery with open heart technique on respiratory functions, functional capacity, and quality of life (QoL). Design. This randomised controlled study applied the Consolidated Standards of Reporting Trials statement. Methods. The study was conducted with two groups: the intervention group ( n = 25 ) and the control group ( n = 25 ). The control group received standard care after coronary artery bypass grafting. On the contrary, the experimental group participated in a PR program created by the researchers in addition to standard care. After coronary artery bypass grafting, the respiratory functions (on the 4th day of clinical care) and QoL (at the 6th week) of both groups were evaluated. The primary outcome measure was the respiratory function (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC). The secondary outcome measure of this study was the QoL. Results. When the average pulmonary function test values of the patients were examined, the mean FVC and FEV1 values of the patients in the intervention group on the 4th day of clinical care were significantly higher with a medium level size effect than the control group ( p = 0.027 ; effect size d = 0.643 ; p < 0.024 ; effect size d = 0.658 , respectively). At the postoperative 6th week measurement of QoL, a decrease was observed in all subdimensions of the scale, albeit less in the intervention group ( p < 0.05 ). There was a decrease in both the mental and physical component summary of QoL ( p < 0.05 ). Conclusion. The results of this study revealed that pulmonary rehabilitation applied to patients who have undergone coronary artery bypass graft recover their functional capacity faster.

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Benson’s Relaxation for Fatigue Patient with Coronary Artery Disease

Caring: Indonesian Journal of Nursing Science ◽

10.32734/ijns.v2i1.4170 ◽

2020 ◽

Vol 2 (1) ◽

pp. 63-69

Author(s):

Mulyanti Roberto Muliantino ◽

Tuti Herawati ◽

Masfuri

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiac Rehabilitation ◽

Recovery Period ◽

Intervention Group ◽

Relaxation Technique ◽

Pharmacological Intervention ◽

Control Group ◽

Artery Disease ◽

And Control

Fatigue is the major symptoms in patients with coronary artery disease, during recovery period after cardiac events and during cardiac rehabilitation. Benson’s relaxation is one of relaxation as modalities therapy to reduce fatigue, however few studies related to this technique in planned intervention. This study was to measure the effectiveness of Benson’s relaxation in fatigue of coronary artery disease patients during cardiac rehabilitation. It was a quasi-experimental pretest posttest control group design. This study included 29 respondents in Dr.M. Djamil Hospital were assigned to intervention group which receiving Benson’s relaxation technique (n=15) and control group with routine care (n=14). Benson’s relaxation technique was administered for 5 days 2 times a day, each 20 minutes to intervention group. Fatigue was measured using Maastricht Questionnaire (MQ). The result indicated significant reduction in mean of fatigue between intervention and control group (p value < 0,001). The study concluded that Benson’s relaxation technique is an effective non-pharmacological intervention to reduce fatigue in coronary artery disease patients. Keywords: Benson’s relaxation; fatigue; coronary artery disease

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Cardiac Rehabilitation

Physical and rehabilitation medicine, medical rehabilitation ◽

10.36425/rehab64287 ◽

2021 ◽

Vol 3 (1) ◽

pp. 24-39

Author(s):

Andrey M. Sarana ◽

Tatyana A. Kamilova ◽

Svetlana V. Lebedeva ◽

Dmitry A. Vologzhanin ◽

Alexander S. Golota ◽

...

Keyword(s):

Coronary Artery ◽

Cardiovascular Diseases ◽

Cardiac Rehabilitation ◽

Artery Bypass ◽

Typical Feature ◽

Coronary Syndrome ◽

Valuable Treatment ◽

Significant Clinical Improvement ◽

Artery Disease ◽

Current Guidelines

Cardiac rehabilitation based on exercise therapy is a valuable treatment for patients with a broad spectrum of cardiovascular diseases. Current guidelines support its use in patients with stable chronic heart failure and coronary artery disease, after myocardial infarction, acute coronary syndrome, coronary artery bypass grafting, coronary stent placement, and valve surgery. Its use in these conditions is supported by a robust body of research demonstrating improved clinical outcomes. The significant clinical improvement obtained through the regular training in patients with cardiovascular diseases is the result of a complex interplay of different effects: 1) improved cardiopulmonary efficiency and pulmonary functional capacity; 2) amelioration of myocardial perfusion by reducing endothelial dysfunction and by inducing new vessel formation; 3) improved myocardial contractility; 4) counteract the muscle wasting and cachexia; 5) reduction of the systemic inflammation; 6) attenuation of the sympathoexcitation, a typical feature of CHF, even in the persistence of cardiac dysfunction. Despite this evidence, cardiac rehabilitation referral and attendance remains low and interventions to increase its use need to be developed.

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P1839Platelet aggregability evaluation in patients with acute coronary syndromes scheduled for coronary artery bypass graft. The PLAT-CABG study

European Heart Journal ◽

10.1093/eurheartj/ehz748.0591 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C A K Nakashima ◽

L A O Dallan ◽

L A F Lisboa ◽

L A Hajjar ◽

A M Soeiro ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Intervention Group ◽

Control Group ◽

P Value ◽

Artery Bypass Graft ◽

Platelet Aggregability

Abstract Background Dual antiplatelet therapy is recommended for patients (pts) with acute coronary syndromes (ACS). However, 10–15% of pts have indication of coronary artery bypass graft (CABG) for the index event and current guidelines recommend stopping clopidogrel at least 5 days prior to CABG. This waiting time could increase hospital length of stay, thus having negative impacts on costs and clinical complications. Purpose To evaluate if release to CABG based on platelet aggregability by Multiplate AnalyzerTM would be non-inferior in comparison with common practice (5 days) in terms of 24-hours post-CABG bleeding. Methods The PLAT-CABG (NCT 02516267) is a randomized, open label, non-inferiority trial (boundary 25%) testing a strategy of platelet aggregability-guided release to CABG versus standard-of-care on the primary endpoint of chest tube drainage in the first 24 hours post CABG. A total of 190 pts admitted with ACS, treated with aspirin + clopidogrel and with indication for CABG, were assigned to clopidogrel discontinued 5 days prior to CABG (control group) vs. daily measurements of platelet aggregability to ADP using Multiplate AnalyzerTM (intervention group) with CABG occurring after recovering from platelet inhibition (pre-defined as a threshold of 46 AU). Results The main results are depicted in the table Main results of PLAT-CABG study Variables Control Group (n=95) Intervention Group (n=95) P-value for superiority P-value for non-inferiority Chest tube drainage (mL), Median (25th–75th) 350 (250–500) 350 (250–500) 0.680 0.001 Time symptom to CABG (hours), Median (25th–75th) 191 (150–281) 166 (119–225) <0.001 NA Time surgery indication to CABG (hours), Median (25th–75th) 136 (112–161) 112 (66–142) <0.001 NA CABG = coronary artery bypass graft. Conclusion Platelet-aggregability guided release to CABG is non-inferior to standard of care in ACS patients awaiting CABG in terms of peri-operative bleeding and significantly shortens the time to CABG. Acknowledgement/Funding Roche Diagnostica Brazil

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Preventive Use of Ascorbic Acid For Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

The Heart Surgery Forum ◽

10.1532/hsf.1938 ◽

2018 ◽

Vol 21 (5) ◽

pp. E415-E417 ◽

Cited By ~ 4

Author(s):

Mohsen Mirmohammadsadeghi ◽

Amir Mirmohammadsadeghi ◽

Mahsa Mahmoudian

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

Vitamin C ◽

Ejection Fraction ◽

Artery Bypass ◽

Bypass Graft ◽

Intervention Group ◽

Functional Class ◽

Control Group ◽

Artery Bypass Graft

Background: Atrial fibrillation is one of the most frequent complications and a major risk of morbidity and mortality after cardiac surgery. Antioxidants such as vitamin C are used for prevention of this arrhythmia. Different results of studies have been reported, but most of them have shown efficiency of vitamin C in prophylaxis of postoperative AF. We tried to examine this efficacy with larger sample size. Methods: Three hundred and fourteen on pump coronary artery bypass graft surgery alone. Patients were divided into two groups: The intervention group received vitamin C (N = 160) and the control group did not receive any (N = 154). Intervention group was administered two grams of vitamin C intravenously (IV) 24 hours preoperatively, 500 mg every 12 hours IV for 48 hours in ICU, and 500 mg every 12 hours PO for 48 hours in ward. Continuous monitoring in ICU and three times a day ECG was used for AF detection. The two groups were compared. Results: The two groups were matched in terms of age, sex, LA size, ejection fraction, functional class, and TSH level. Of the patients, 244 were male. Mean age was 62 years (40-84 years) in both groups. M/F ratio was four in both groups. Functional class and ejection fraction were the same in both groups. There was no mean TSH level difference. AF occurrence in vitamin C group was 7.6 % and in control group was 7.8 %. There was no difference in ICU or hospital stay. Conclusions: Prophylactic use of vitamin C does not further reduce postoperative atrial fibrillation in on pump CABG patients.

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Early mobilization reduces delirium after coronary artery bypass graft surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320947230 ◽

2020 ◽

Vol 28 (9) ◽

pp. 566-571

Author(s):

Fahimeh Shirvani ◽

Seyed Ali Naji ◽

Elham Davari ◽

Mohsen Sedighi

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Postoperative Delirium ◽

Artery Bypass ◽

Bypass Graft ◽

Intervention Group ◽

Control Group ◽

Bypass Grafting ◽

Artery Bypass Grafting

Background Postoperative delirium is common in patients undergoing coronary artery bypass grafting, characterized by cognitive decline. This study aimed to evaluate the effect of early planned mobilization on delirium after coronary artery bypass grafting. Methods This double-blind randomized clinical trial enrolled 92 consecutive patients who underwent coronary artery bypass grafting from September to December 2018. The patients were divided into two groups of 46: a mobilization protocol was applied in the intervention group in the first 2 days after surgery; the control group received routine nursing care only. Demographic data, medical records, and Neecham confusion scores were analyzed. Results Patients in the control group used cigarettes (31.1% vs. 11.1%, p = 0.020) and opium poppy for recreation (35.6% vs. 8.9%, p = 0.002) more frequently, had longer intubation times (11.91 ± 3.87 vs. 10.23 ± 2.71 h, p = 0.020), and fewer blood components infused (15.6% vs. 33.3%, p = 0.05). More patients in the intervention group had normal function on the 2nd postoperative day compared to the control group (25 vs. 2, respectively, p = 0.001). The intervention group had significantly higher Neecham scores on postoperative day 2 (22.49 ± 2.03 vs. 26.82 ± 2.10, p = 0.001). Multivariable analysis showed significant associations between Neecham score and age ( p = 0.022), ejection fraction ( p = 0.015), myocardial infarction ( p = 0.016), systolic pressure ( p = 0.009), and diastolic pressure ( p = 0.008). Conclusions Early planned mobilization was effective in reducing postoperative delirium in patients undergoing coronary artery bypass grafting.

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The Impact of Peplau's Therapeutic Communication Model on Anxiety and Depression in Patients Candidate for Coronary Artery Bypass

Clinical Practice and Epidemiology in Mental Health ◽

10.2174/1745017901410010159 ◽

2014 ◽

Vol 10 (1) ◽

pp. 159-165 ◽

Cited By ~ 7

Author(s):

Kourosh Zarea ◽

Solmaz Maghsoudi ◽

Bahman Dashtebozorgi ◽

Mohammad Hossin Hghighizadeh ◽

Mostafa Javadi

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Intervention Group ◽

Anxiety And Depression ◽

Control Group ◽

Communication Model ◽

Therapeutic Communication ◽

Before And After ◽

The Impact

Background and Objective:Anxiety and depression are among the psychological disorders in heart surgeries. Establishing a simple communication is essential to reduce anxiety and depression. Hence, the objective of the present studywas to examine the impact of Peplau therapeutic communication model on anxiety and depression in patients, who were candidate for coronary artery bypass in Al-Zahra Heart Hospital, Shiraz during 2012-2013.Methods:This is a clinical trial in which 74 patients were randomly divided into intervention and control groups, each consisted of 37 patients. Anxiety and depression levels were assessed before, and two and four months after intervention using the Hospital Anxiety and Depression Scale (HADS). Seven therapeutic communication sessions were held in four stages. Data were analyzed with the SPSS (version 16) using analysis of covariance.Results:The mean anxiety and depression levels decreased in the intervention group after the therapeutic communication (p<0.01). Anxiety scores in the intervention group before and after intervention were 10.23 and 9.38, respectively. While the corresponding scores in the control group were 10.26 and 11.62, respectively. Depression scores in the intervention group before and after intervention were 11 and 9.13, respectively. The corresponding scores in the control group were 11.30 and 12.08, respectively.Conclusion:The results demonstrated the positive role of therapeutic communication in reducing anxiety and depression of the patients. Therefore, the therapeutic communication is recommended as a simple, cost effective and efficient method in this area.

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