Elsevier

Heart & Lung

Volume 38, Issue 6, November–December 2009, Pages 459-468
Heart & Lung

Issues in cardiovascular nursing
Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden

https://doi.org/10.1016/j.hrtlng.2009.01.010Get rights and content

Objective

Older adults with poor functioning preoperatively are at risk for delayed recovery and more impaired outcomes after coronary artery bypass surgery (CABS). The study objective was to determine whether a 6-week early recovery telehealth intervention, designed to improve self-efficacy and management related to symptoms after CABS, was effective in improving outcomes (physical activity, physiologic, and psychologic functioning) for older adults (aged > 65 years) with higher disease burden.

Methods

A descriptive, repeated-measures experimental design was used. Follow-up data were collected at 3 and 6 weeks and 3 months after CABS. Subjects were drawn from a larger randomized clinical trial. Parent study subjects who had high disease burden preoperatively (physical component score of < 50 on the Medical Outcome Study Short Form-36 and RISKO score of > 6) were included (N = 55), with 23 subjects in the early recovery intervention group and 31 subjects in the usual care group (n = 31). Subjects ranged in age from 65 to 85 years (M = 71.6 + 5.1 years).

Results

There was a significant main effect by group (F[1,209] = 4.66, P < .05). The intervention group had a least square means of 27.9 kcal/kg/d of energy expenditure compared with the usual care group of 26.6 kcal/kg/d per the RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA). Both groups had significantly improved physical (F[2,171] = 3.26, P < .05) and role-physical (F[2,171] = 6.64, P < .005) functioning over time.

Conclusion

The subgroup of subjects undergoing CABS with high disease burden were responsive to an early recovery telehealth intervention. Improving patients' physical activity and functioning can reduce morbidity and mortality associated with poor functioning after cardiac events.

Section snippets

Related Literature

Functioning improvements after cardiac revascularization appear to improve linearly over time.1, 3, 28, 29, 30 However, recent studies indicate that pre-procedural comorbidities,9, 10, 31 illness severity,2, 32 daily functioning abilities,33 and functional status34, 35 can predict HRQoL and recovery of functioning after cardiac revascularization. These findings corroborate the conclusion that there are patients with cardiac disease who do not experience improved health status or HRQoL and may

Conceptual Framework

The early recovery telehealth intervention in this study focused on using symptom management strategies to improve physical activity and functioning outcomes after CABS. The conceptual framework used for this study and the development of the intervention were based on the health outcomes research47 and symptom management48 conceptual models. In the symptom management model, it is assumed that the person, environment, and health and illness domains are affected by specific knowledge, skills,

Design

In the parent study, a randomized, 2-group (N = 280), repeated-measures design was used, with one group receiving the early recovery telehealth intervention plus usual care and the comparison group receiving only usual care. Data measurements were obtained before discharge (baseline measures), 3 and 6 weeks, and 3 and 6 months postoperatively among older adults (aged ≥ 65 years) who had undergone CABS. The 6-week symptom management telehealth intervention, developed by the investigators,49 was

Physical activity

In this study, physical activity was measured at baseline using the Modified 7-day Activity Interview, which provided baseline data (before having CABS) on the subject's average kilocalories/kilogram/day expended, average number of minutes spent exercising/week, and average minutes/day spent in moderate or greater activity. At 3 and 6 weeks and 3 and 6 months, physical activity and exercise were measured by the RT3 accelerometer providing average kilocalories/kilogram/day expended, which is an

Discussion

Physical well-being is important for patients with chronic conditions such as heart disease, because declines in physical ability and functioning are associated with higher health care use, morbidity, and mortality.9, 67 Cardiac revascularization compared with medical management can reduce overall mortality among older adults,68 although the beneficial outcomes realized from revascularization may be impeded by persistent physical inactivity and lack of exercise. In this study, those patients

Limitations

Findings from this study are limited given this is a subanalysis of a larger randomized clinical trial. In addition, the early recovery intervention examined in this study was not specifically designed for patients after CABS with a higher disease burden; therefore, the effect of the intervention may not have had as much of an impact as a more tailored intervention for this population. Another study limitation is the use of self-report measure of functioning with the MOS SF-36 tool, although

Conclusions and Recommendations

Despite preexisting impairments and higher risk for poor outcomes, older adults with heart disease can derive significant cardiovascular benefits and improved HRQoL from physical activity and exercise.13, 74, 75 Researchers have previously found a major determinant of the level of physical activity achieved and whether patients will maintain exercise are based on their level of activity and exercise before their cardiac event.19 Thus, patients with higher disease burden, who have lower levels

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    Funded by the National Institutes of Health/National Institute of Nursing Research R01 NR007759.

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