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
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 .
Predictors of Smoking Cessation after Coronary Artery Bypass Graft Surgery: Results of a Randomized Trial with 5-Year Follow-up
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
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
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 .