Pre-operative anxiety in patients undergoing coronary artery bypass graft surgery – A cross-sectional study

Pain-related fear among adult patients undergoing open-heart surgery: an interpretative phenomenological analysis

BACKGROUND

One of the sources of anxiety and fear among patients undergoing open-heart surgery is the possibility of experiencing pain, such as sternotomy-related chest pain. Giving them the chance to express their feelings about the potential pain may be effective in reducing their anxiety and may support their coping strategies.

OBJECTIVES

To examine pain-related fear among patients undergoing open-heart surgery and to understand the underlying reasons of their fears.

METHODS

A qualitative interview based on Heidegger's interpretative phenomenological approach was conducted adhering to the COREQ guidelines. Sixteen patients who were undergoing open-heart surgery in the following day were interviewed at the cardiovascular surgery ward of a university hospital. The organization and mapping of the qualitative data was done by using ATLAS.ti 8.0.

RESULTS

The patients who were afraid of experiencing pain after surgery seemed to be more concerned about open-heart surgery itself (such as pain from sternotomy and chest tubes) and the possibility of prolongation of postoperative pain. To cope with these fears, the patients employed a variety of social and self-coping strategies. Trusting the healthcare team, having a high pain tolerance, and having personal thoughts that take precedence over pain-related fear were the key factors explaining not being afraid of experiencing pain.

CONCLUSIONS

This study provides a deeper understanding of the underlying reasons and the needs of patients in controlling their pain-related fears before open-heart surgery. Trusting the healthcare professionals is one of the main factors for patients to control their pain-related fears. To develop a supportive sense of trust and to help patients in controlling their pain-related fears, surgical nurses must dedicate enough time for understanding patients' concerns while planning their nursing care plans. Future studies may focus on exploring the role of nursing interventions and multidisciplinary team approaches on the management of preoperative pain-related fear.

Anxiety and Quality of Life Outcomes After Coronary Artery Bypass Graft Surgery - A Prospective Cohort Study

Improvements in physical and adaptive psychosocial challenges after Coronary artery bypass grafting (CABG) is unclear to what extent these outcomes impact patients' health-related quality of life. This study was to determine the quality of life among patients 3 months after CABG surgery. More specifically, the study examines the contribution of a set of variables on the quality of life. A prospective cohort study was performed over 3 months among 219 adult patients prepared for elective Coronary Artery Bypass Grafting. The data on the baseline measurements Short Form-36 to measure self-reported health-related quality of life and the state-trait anxiety inventory scale to assess anxiety were collected two days before and three months after CABG surgery. The Pearson correlation coefficient was adopted to examine the relationship between confounding, predictor, and dependent variables. Shapiro-Wilk test tested the normality of the distribution of numerical variables. A 2-tailed level of P-value < 0.05 was set to be statistically significant for all analyses. Mean preoperative postoperative physical and mental component score was 34.57 ± 9.6, 43.53 ± 7 and 54.87 ± 1.19, 51.65 ± 9.67, respectively, indicating poor quality of life. Preoperative anxiety uniquely explained with the variation 32.1% and 29.9% and it significantly predicts postoperative physical health quality of life as (β = .535, t = 8.433, P < 0.001) and postoperative mental health quality of life as (β = .475, t = 7.147, P < 0.001) respectively. Significant improvement in physical health over the 3 months was confirmed, but mental health-related quality of life is unconvincing with the substantial contribution of anxiety.

Effectiveness of cognitive-behavioral therapy on perceived stress among patients undergoing percutaneous coronary intervention: A randomized controlled trial

PURPOSE

This study aimed to determine the effectiveness of cognitive-behavioral therapy on perceived stress of patients undergoing percutaneous coronary intervention (PCI).

DESIGN AND METHODS

This was a randomized clinical trial in which the patients under coronary intervention were allocated to two groups, intervention and control by using block randomization. The experiment group received eight sessions of cognitive-behavioral therapy. The patients' perceived stress was measured before, immediately, and 1-month post ntervention.

FINDINGS

The results showed the perceived stress scores changed significantly in the intervention group compared with the control group immediately and 1 month after the intervention. Therefore, the perceived stress level significantly reduced in the patients of the intervention group (p < 0.001).

PRACTICE IMPLICATIONS

Cognitive-behavioral therapy significantly reduced perceived stress in patients undergoing PCI.

Relationship between Psychological Distress and Demographic Characteristics among Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery

Coronary artery bypass graft (CABG) surgery patients often present with anxiety and depression. These symptoms coupled with pain are major concerns and are widely reported among CABG patients. The study aimed to evaluate the relationship between psychological distress and patients’ demographic data. This cross-sectional study in which 178 patients from a surgery ward were selected using the census method. Data were collected using the Hospital Anxiety and Depression Scale and the Brief Pain Inventory (Short Form). The participants’ mean age was 57.49 ± 13.78 years. The majority of participants had a moderate level of anxiety (89.3%) and a moderate level of pain interference (74.7%). Significant differences were noted, with a higher proportion of moderate anxiety level participants aged between 60 and 74 years old, married, and with a tertiary level education (p < 0.05) being found. There were also significant differences between gender (p < 0.05) and pain severity (p < 0.01) across the levels of depression. The levels of anxiety, depression, and pain were significant, especially among older patients. These symptoms should be routinely assessed, and further identification of predictors such as socioeconomic status before the procedure is necessary.

Relationship Between Preoperative Anxiety and Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

BACKGROUND

Atrial fibrillation is a form of arrhythmia that frequently occurs after coronary artery bypass graft surgery. Psychological factors may be involved in the development of atrial fibrillation, although the specific effect of anxiety remains unclear.

PURPOSE

This study was designed to evaluate the relationship between preoperative anxiety levels and atrial fibrillation after coronary artery bypass graft surgery.

METHODS

This descriptive design study recruited a sample of 126 patients. The data were collected by the researcher using a patient information form and the State-Trait Anxiety Scale.

RESULTS

Atrial fibrillation developed in 26.5% of the sample. Those who developed atrial fibrillation had a mean trait anxiety scale score of 40.2 ± 7.8, which is statistically significant. According to the results of logistic regression, it was observed that increased trait anxiety score, increased age, presence of comorbid disease, and noncompliance with respiratory physiotherapy increased the risk of developing atrial fibrillation.

CONCLUSION/IMPLICATIONS FOR PRACTICE

Preoperative anxiety levels were shown to be a significant factor promoting the development of atrial fibrillation after coronary artery bypass graft surgery. The results support measuring anxiety levels in patients as a standard procedure before performing this surgical procedure.

Examining the impact of psychological distress on short-term postoperative outcomes after elective endovascular aneurysm repair (EVAR)

PURPOSE

Preoperative psychological factors have an impact on postoperative outcomes and there is a paucity of research in vascular surgery. The objective of this study was to examine the impact of preoperative psychological factors on short-term postoperative outcomes in an infrarenal endovascular aneurysm repair (EVAR) cohort.

METHODS

A prospective, multi-centre observational study was conducted across three vascular units in England. English-speaking participants who were older than 18 years, able to provide informed consent and awaiting an elective standard infrarenal EVAR were eligible for the study. A total of 46 patients undergoing elective infrarenal AAA repair were assessed preoperatively with the State Trait Anxiety Inventory (STAI), Beck's Depression Inventory (BDI-II) and Life Orientation Test-Revised (LOT-R). Data on five short-term postoperative outcomes was collected and analysed using Spearman's rank correlations.

RESULTS

Higher preoperative anxiety levels (ρ = 0.38, p = 0.01), and depression scores (ρ = 0.36, p = 0.02) were moderately correlated with an increased length of postoperative critical care stay. Higher levels of preoperative depression were moderately correlated with greater postoperative opioid analgesia use (ρ = 0.34, p = 0.02). No correlation was witnessed between optimism scores and postoperative outcomes. No correlation was witnessed with respect to total length of stay, number of complications, or time to mobilisation.

CONCLUSIONS

There is a potential link between preoperative psychological well-being and short-term postoperative outcomes in an EVAR cohort. Further work is necessary to validate this link and examine the role of preoperative interventions in optimising the psychological well-being of patients undergoing EVAR.

Investigating the Effect of Acupressure on the Patients' Anxiety Before Open-Heart Surgery: A Randomized Clinical Trial

BACKGROUND

Anxiety is a common complaint of patients before diagnostic or therapeutic invasive procedures, especially before open-heart surgery. The most well-known method to reduce anxiety is the use of sedatives, which have pronounced side effects.

OBJECTIVES

The purpose of this study was to determine the effect of acupressure on anxiety in patients undergoing open-heart surgery.

METHOD

This is a randomized clinical trial study conducted on 90 patients who were candidates for open-heart surgery. The patients were randomly assigned into either intervention or control groups. Acupressure intervention was applied at three real acupoints over two consecutive days in the intervention group. The control group received acupressure on sham points. We used Spielberger State-Trait Anxiety Inventory to assess anxiety in our study.

RESULTS

The results showed that before acupressure, there was no statistically significant difference between state anxiety scores and intergroup traits, and this difference was only significant in state anxiety after the second intervention. State and trait anxiety were significant before and after the intervention in the test group, respectively include (p < 0.001) (p = 0.01), but these changes in the control group did not show a statistically significant difference. After completing the second phase of the intervention at the actual sites, systolic blood pressure (p = 0.007) and heart rate (p = 0.001) decreased significantly. However, acupressure did not have a significant effect on diastolic blood pressure in any of the groups.

CONCLUSION

Based on the results of this study, the application of acupressure in patients who are candidates for open-heart surgery can reduce their state anxiety. Further larger-scale and rigorous studies are warranted.

Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study

Perioperative anxiety could negatively affect surgery outcomes, and cardiac diseases have long been known to be an independent risk factor for anxiety development. However, little is known about preoperative anxiety in Nepalese adult cardiac patients waiting for surgery. The primary objectives of this study were to: (1) clarify the levels of preoperative anxiety in Nepalese adult cardiac patients waiting for open heart surgery; (2) identify factors associated with preoperative anxiety; and (3) evaluate any possible factors associated with patients' desire to obtain information related to their heart surgery.This is a prospective observational study for patients already scheduled for cardiac surgery at a core medical institution in Kathmandu, Nepal. We collected sociodemographic and clinical characteristics of the patients from their medical charts, and assessed their preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale. We performed descriptive analyses of the collected data. Further, we employed regression models to assess to the objectives of the study.In total, 140 patients participated, and data of 123 (87.9%) were used for analysis. 58.5% of the participants had preoperative anxiety. Female gender (OR 0.31, 95% CI 0.15-0.65, P < .001) and past anesthesia exposure (OR 2.38, 95% CI 1.01-5.62, P < .05) were identified as risk factors for developing anxiety before cardiac surgery. Further, female gender (IRR 0.80, 95% CI 0.67-0.94, P < .001), higher education levels (IRR 1.18, 95% CI 1.01-1.40, P < .05), and higher preoperative anxiety (IRR 1.44, 95% CI 1.21-1.73, P < .001) could lead to higher levels of desire to acquire information related to the procedure.The study concluded that more than a half of the cardiac surgery patients experiences preoperative anxiety; female gender and having past anesthesia exposure are the risk factors. Anxious patients have more desire to acquire knowledge about the procedure. Thus, the evaluation and adequate management of preoperative anxiety should be proposed in high-risk groups.