Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning

doi:10.1016/S0147-9563(03)00036-0

Heart & Lung

Volume 32, Issue 3, May–June 2003, Pages 147-158

https://doi.org/10.1016/S0147-9563(03)00036-0 Get rights and content

Abstract

Objective

The purpose of this study is to determine the impact of a home communication intervention (HCI) for ischemic heart failure Coronary Artery Bypass Graft (CABG) patients ≥ 65 years of age on self-efficacy, coronary artery disease risk factor modification and functioning posthospitalization.

Design

A randomized clinical trial with repeated measures was used.

Sample

A subsample of ischemic heart failure CABG surgery patients (n = 35) was drawn from the parent study of 180 CABG patients.

Results

HCI participants (n = 18) had significantly higher adjusted mean self-efficacy scores [F(1, 29) = 6.40, P < .05] and adjusted mean levels of functioning (physical, general health, mental, and vitality functioning) compared with the routine care group (n = 17), using repeated measures analysis of covariance with baseline scores as covariates. There were also significant effects of time on bodily pain and role emotional functioning. Significantly higher exercise adherence (t = 3.09, P < .01) and lower reported stress (t = 3.77, P < .01) at 3 months after surgery was reported by HCI subjects.

Conclusions

Data from this pilot study can be used to strengthen the HCI intervention with more tailored strategies for vulnerable subgroups of CABG patients.

Section snippets

Self-efficacy among CABG patients with ischemic heart failure

Social cognitive theory postulates that individuals possess a belief system referred to as self-efficacy and giving them a measure of control over their thoughts, feelings, motivation and actions.6 Factors contributing to self-efficacy include past experience, verbal persuasion, modeling (eg, vicarious experience), physiological state, and affective state. Processes which promote embracing of health-promoting behaviors include adoption of new personal change, generalized use under differing

Purpose and research questions

The ischemic HF CABG subset of patients has needs for ongoing management of chronic health problems of both CAD and HF. The major purpose of this randomized pilot study was to test the impact of a home communication intervention (HCI) for ischemic HF CABG patients on self-efficacy, coronary artery disease (CAD) risk factor modification and functioning (physiological and psychosocial) in the early recovery period. The specific research goal was to determine whether elderly ischemic HF CABG

Research design

An experimental design with repeated measures was used for the parent pilot study.

Subjects were randomized to Group 1: (HCI) or Group 2: (RC only). The HCI was delivered to the subjects using a device called the Health Buddy, manufactured by Health Hero Network. It is a small device which attaches to the patient’s telephone as a means of communication and provides patients with: a) assessment of patient symptoms (eg, fatigue or sleep problems) and strategies to manage reported symptoms, b) CAD

Findings

The 2 groups were compared with determine whether there were differences in self-efficacy as measured by the BEES tool. Refer to Figure 1 for the summary of unadjusted mean scores. Using repeated measures analysis of covariance (RM ANCOVA) with baseline BEES score as the covariate, there was a significant difference in the adjusted mean scores between HCI and RC groups, with HCI participants having significantly higher [F (1,29) = 6.40, P < 0.02] mean self-efficacy scores of 50.6 (standard

Discussion

Decreasing lengths of hospitalization and increasingly complex health care problems among patients challenge the traditional paradigms of healthcare delivery. Not only do clinicians need to identify those individual patients or aggregate populations in need of transition after hospitalization, they are further challenged to provide transitional and ongoing chronic disease management in an efficient and cost-effective manner. Findings from this pilot study demonstrate promise for the potential

References (81)

S.A. Hunt et al.
ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult
J Am Coll Cardiol
(2001)
M. Haan et al.
Trends in cardiovascular disease incidence and survival in the elderly
Ann Epidemiol
(1996)
S. Perkins et al.
Self-efficacy expectation, behavior performance, and mood status in early recovery from percutaneous transluminal coronary angioplasty
Heart Lung
(1998)
C.K. Ewart et al.
Effects of early postmyocardial infarction exercise testing on self-perception and subsequent physical activity
Am J Cardiol
(1983)
B. Carlson et al.
Self-care abilities of patients with heart failure
Heart Lung
(2001)
J.S. Forrester et al.
27th Bethesda Conferencematching the intensity of risk factor management with the hazard for coronary disease events. Task Force 4. Efficacy of risk factor management
J Am Coll Cardiol
(1996)
A.M. Zafari et al.
Secondary prevention of coronary heart disease
Arch Phys Med Rehabil
(1998)
S.J. Zyzanski et al.
Medical and psychosocial outcomes in survivors of major heart surgery
J Psychosom Res
(1981)
S. Barnason et al.
Functional status outcomes among coronary artery bypass graft (CABG) patients over time
Heart Lung
(2000)
L.S. Evangelista et al.
Relationship between psychosocial variables and compliance in patients with heart failure
Heart Lung
(2001)

N.T. Artinian et al.

Sex differences in patient recovery patterns after coronary artery bypass surgery

Heart Lung

(1995)

B.A. Ruiz et al.

Predictors of general activity 8 weeks after cardiac surgery

Appl Nurs Res

(1992)

R. Kornowski et al.

Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure

Am Heart J

(1995)

F.J. Pashkow

Issues in contemporary cardiac rehabilitationA historical perspective

J Am Coll Cardiol

(1993)

D.L. Carroll

The importance of self-efficacy expectations in elderly patients recovering from coronary artery bypass surgery

Heart Lung

(1995)

N.B. Shah et al.

Prevention of hospitalizations for heart failure with an interactive home monitoring program

Am Heart J

(1998)

J.A. West et al.

A comprehensive management system for heart failure improves clinical outcomes and reduces medical resource utilization

Am J Cardiol

(1997)

J.B. Croft et al.

National trends in the initial hospitalization for heart failure

Journal of the American Geriatr Soc

(1997)

J.B. Croft et al.

Heart failure survival among older adults in the United Statesa poor prognosis for an emerging epidemic in the Medicare population

Arch Intern Med

(1999)

C. Currie et al.

Patterns and costs of hospital care for coronary heart disease related and not related to diabetes

Heart

(1997)

A. Bandura

Social foundations of thought and action: a social cognitive theory

(1986)

A. Bandura

Self-efficacy: the exercise of control

(1997)

J.K. Allen et al.

Factors related to functional status after coronary artery bypass surgery

Heart Lung

(1990)

S.K. Brown et al.

The relationship between self-efficacy and walking in the rehabilitation of postoperative CABG patients

Rehabilitation Nursing Research

(1995)

S. Gortner et al.

Self-efficacy and activity level following cardiac surgery

J Adv Nurs

(1990)

L.S. Jenkins et al.

Correlates of self-efficacy expectation and prediction of walking behavior in cardiac surgery elders

Ann Behav Med

(1998)

B.B. Tack et al.

Nurse-monitored cardiac recoverya description of the first 8 weeks

Heart Lung

(1990)

H. Ni et al.

Factors influencing knowledge of and adherence to selfcare among patients with heart failure

Arch Intern Med

(1999)

S.R. Gortner et al.

Improving recovery following cardiac surgerya randomized clinical trial

J Adv Nurs

(1988)

V.J. Strecher et al.

The role of self-efficacy in achieving health behavior change

Health Educ Behav

(1986)

B.K. Sampson et al.

Health care needs of coronary artery bypass graft surgery patients at discharge

Dimens Crit Care Nurs

(1998)

American Heart Association. Heart and Stroke Facts: 2002. Dallas: American Heart Association;...

S.C. Smith et al.

AHA Consensus Panel Statementpreventing heart attack and death in patients with coronary disease

Circulation

(1995)

J.L. Roitman et al.

A new model for risk stratification and delivery of cardiovascular rehabilitation services in the long-term clinical management of patients with coronary artery disease

J Cardiopulm Rehabil

(1998)

N.H. Miller

The use of the telephone in cardiac and pulmonary rehabilitation

J Cardiopulm Rehabil

(1996)

M.L. Stefanick et al.

Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol

N Engl J Med

(1998)

N.S. Redeker et al.

Health patterns of cardiac surgery clients using home health care nursing services

Public Health Nurs

(1996)

N.S. Redeker et al.

First postoperative week activity patterns and recovery in women after coronary artery bypass surgery

Nurs Res

(1994)

J. Wilson-Barnett

Assessment of recoverywith special reference to a study with post-operative cardiac patients

J Adv Nurs

(1981)

J. Lovvorn

Coronary artery bypass surgeryhelping patients cope with postop problems

Am J Nurs

(1982)

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Original articleImpact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning

Abstract

Objective

Design

Sample

Results

Conclusions

Section snippets

Self-efficacy among CABG patients with ischemic heart failure

Purpose and research questions

Research design

Findings

Discussion

J Am Coll Cardiol

Ann Epidemiol

Heart Lung

Am J Cardiol

Heart Lung

J Am Coll Cardiol

Arch Phys Med Rehabil

J Psychosom Res

Heart Lung

Heart Lung

Heart Lung

Appl Nurs Res

Am Heart J

J Am Coll Cardiol

Heart Lung

Am Heart J

Am J Cardiol

National trends in the initial hospitalization for heart failure

Journal of the American Geriatr Soc

Heart failure survival among older adults in the United Statesa poor prognosis for an emerging epidemic in the Medicare population

Arch Intern Med

Patterns and costs of hospital care for coronary heart disease related and not related to diabetes

Heart

Social foundations of thought and action: a social cognitive theory

Self-efficacy: the exercise of control

Factors related to functional status after coronary artery bypass surgery

Heart Lung

The relationship between self-efficacy and walking in the rehabilitation of postoperative CABG patients

Rehabilitation Nursing Research

Self-efficacy and activity level following cardiac surgery

J Adv Nurs

Correlates of self-efficacy expectation and prediction of walking behavior in cardiac surgery elders

Ann Behav Med

Nurse-monitored cardiac recoverya description of the first 8 weeks

Heart Lung

Factors influencing knowledge of and adherence to selfcare among patients with heart failure

Arch Intern Med

Improving recovery following cardiac surgerya randomized clinical trial

J Adv Nurs

The role of self-efficacy in achieving health behavior change

Health Educ Behav

Health care needs of coronary artery bypass graft surgery patients at discharge

Dimens Crit Care Nurs

AHA Consensus Panel Statementpreventing heart attack and death in patients with coronary disease

Circulation

A new model for risk stratification and delivery of cardiovascular rehabilitation services in the long-term clinical management of patients with coronary artery disease

J Cardiopulm Rehabil

The use of the telephone in cardiac and pulmonary rehabilitation

J Cardiopulm Rehabil

Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol

N Engl J Med

Health patterns of cardiac surgery clients using home health care nursing services

Public Health Nurs

First postoperative week activity patterns and recovery in women after coronary artery bypass surgery

Nurs Res

Assessment of recoverywith special reference to a study with post-operative cardiac patients

J Adv Nurs

Coronary artery bypass surgeryhelping patients cope with postop problems

Am J Nurs

Original article
Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning