A randomized controlled trial on the effectiveness of a portable patient education video prior to coronary angiography and angioplasty.

INTRODUCTION: Time limitations in busy clinical settings may impede adequate explanation of coronary angiography/angioplasty. We aim to evaluate the effectiveness of a portable patient education video in improving knowledge and allaying patient's anxiety. METHODS: Consecutive patients undergoing coronary angiography/angioplasty were prospectively recruited over 1 year from a tertiary cardiac institution. A 3-min animated patient education video on the procedure was developed to be shown on a tablet. Patients were randomized 3:1 into an intervention group (video plus routine care) versus a control group (routine care). Before the procedure, a self-administered questionnaire was conducted in both groups. The questionnaire was repeated post-video in the intervention group. RESULTS: A total of 332 patients (252 intervention groups, 80 controls) were recruited. At baseline, the intervention group had lower knowledge scores (p = .022) and similar anxiety scores (p = .323) compared with the control group. After the video, the intervention group had significantly higher knowledge scores (p ≤ .001) and lower anxiety scores (p ≤ .001). Within the intervention group, there was a significant increase in knowledge scores (p ≤ .001) and reduction in anxiety scores (p ≤ .001) before versus after watching the video. In the subset of patients who had previously undergone a similar procedure (n = 131), there was also significant improvement in knowledge scores and reduction in anxiety scores (p < .001). The video is accessible at https://youtu.be/R8AdaIbNq7Y. CONCLUSION: The video improved knowledge and reduced anxiety in patients undergoing coronary angiography and angioplasty. This is a useful adjunct to incorporate into existing workflows to improve patient care.

Independent Predictors of Cardiac Mortality and Hospitalization for Heart Failure in a Multi-Ethnic Asian ST-segment Elevation Myocardial Infarction Population Treated by Primary Percutaneous Coronary Intervention.

We aimed to identify independent predictors of cardiac mortality and hospitalization for heart failure (HHF) from a real-world, multi-ethnic Asian registry [the Singapore Myocardial Infarction Registry] of ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention. 11,546 eligible STEMI patients between 2008 and 2015 were identified. In-hospital, 30-day and 1-year cardiac mortality and 1-year HHF rates were 6.4%, 6.8%, 8.3% and 5.2%, respectively. From the derivation cohort (70% of patients), age, Killip class and cardiac arrest, creatinine, hemoglobin and troponin on admission and left ventricular ejection fraction (LVEF) during hospitalization were predictors of in-hospital, 30-day and 1-year cardiac mortality. Previous ischemic heart disease (IHD) was a predictor of in-hospital and 30-day cardiac mortality only, whereas diabetes was a predictor of 1-year cardiac mortality only. Age, previous IHD and diabetes, Killip class, creatinine, hemoglobin and troponin on admission, symptom-to-balloon-time and LVEF were predictors of 1-year HHF. The c-statistics were 0.921, 0.901, 0.881, 0.869, respectively. Applying these models to the validation cohort (30% of patients) showed good fit and discrimination (c-statistic 0.922, 0.913, 0.903 and 0.855 respectively; misclassification rate 14.0%, 14.7%, 16.2% and 24.0% respectively). These predictors could be incorporated into specific risk scores to stratify reperfused STEMI patients by their risk level for targeted intervention.