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Factors associated with patient outcomes following same-day discharge percutaneous coronary intervention

University of British Columbia

Coronary artery disease continues to cause the majority of deaths and disability in Canada; the resultant demand for percutaneous coronary intervention (PCI) exercises constant pressure on health care systems to meet the growing needs of patients. The practice of same-day discharge PCI has emerged as a medically safe option to optimize resource utilization and to improve access to care. The purpose of this study was to describe elective same-day discharge PCI patients' health behaviour in the two to five days following their procedure. The concepts of cardiac self-efficacy and self-care agency provided a theoretical framework. A telephone questionnaire drawing from existing validated tools was developed to explore the relationships between patient and procedural characteristics, and individuals' capacity to care for themselves following PCI in a study sample of 98 participants. The findings revealed a high degree of adherence to the discharge guidelines, including following medication regimen, making a follow-up appointment, and managing the dressing. Yet, within 24 hours of discharge, over 30% of patients experienced symptoms of myocardial ischemia, with 80% opting to take no action, and a further 10% of the total sample presented to an emergency department. Participants' awareness of how to appropriately manage their chronic disease was low: although over 70% of patients understood the results of their PCI procedure, 38% believed that they no longer had coronary artery disease, 50% did not know how to prevent their heart disease from worsening, and 77% did not intend to participate in cardiac rehabilitation. To identify factors associated with lower levels of CSE and SCA, multiple linear regression analysis was carried out. Lack of social support emerged as a significant and consistent predictor of poorer outcomes. In addition, other aspects of psychoemotional distress were also significant factors in patients' cardiac self-efficacy and self-care agency in the recovery period. Same-day discharge PCI presents a feasible and safe option for delivery of care for most patients, but requires improved bridging between acute intervention and chronic disease management, and the identification of tailored interventions or support for individuals at higher risk during the recovery period.

Text

2011-02-25

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http://hdl.handle.net/2429/31802

Nursing

University of British Columbia

Graduate