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1.
BMJ Open ; 9(2): e022995, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30826789

RESUMO

INTRODUCTION: Approximately 400 000 Americans and 36 000 Canadians undergo cardiac surgery annually, and up to 56% will develop chronic postsurgical pain (CPSP). The primary aim of this study is to explore the association of pain-related beliefs and gender-based pain expectations on the development of CPSP. Secondary goals are to: (A) explore risk factors for poor functional status and patient-level cost of illness from a societal perspective up to 12 months following cardiac surgery; and (B) determine the impact of CPSP on quality-adjusted life years (QALYs) borne by cardiac surgery, in addition to the incremental cost for one additional QALY gained, among those who develop CPSP compared with those who do not. METHODS AND ANALYSES: In this prospective cohort study, 1250 adults undergoing cardiac surgery, including coronary artery bypass grafting and open-heart procedures, will be recruited over a 3-year period. Putative risk factors for CPSP will be captured prior to surgery, at postoperative day 3 (in hospital) and day 30 (at home). Outcome data will be collected via telephone interview at 6-month and 12-month follow-up. We will employ generalised estimating equations to model the primary (CPSP) and secondary outcomes (function and cost) while adjusting for prespecified model covariates. QALYs will be estimated by converting data from the Short Form-12 (version 2) to a utility score. ETHICS AND DISSEMINATION: This protocol has been approved by the responsible bodies at each of the hospital sites, and study enrolment began May 2015. We will disseminate our results through CardiacPain.Net, a web-based knowledge dissemination platform, presentation at international conferences and publications in scientific journals. TRIAL REGISTRATION NUMBER: NCT01842568.

2.
CMAJ ; 190(Suppl): S6-S8, 2018 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-30404839
4.
Can J Cardiol ; 34(7): 850-862, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29960614

RESUMO

Worldwide, more than 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to home, are inadequate. On the surgical ward, vital signs evaluation usually occurs only every 4-8 hours. Reduced in-hospital ward monitoring, followed by no vital signs monitoring at home, leads to thousands of cases of undetected/delayed detection of hemodynamic compromise. In this article we review work to date on postoperative remote automated monitoring on surgical wards and strategy for advancing this field. Key considerations for overcoming current barriers to implementing remote automated monitoring in Canada are also presented.

5.
Qual Health Res ; 28(11): 1769-1787, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29916769

RESUMO

Symptom recognition and self-management is instrumental in reducing the number of deaths related to coronary artery disease (CAD) in women. The purpose of this study was to synthesize qualitative research evidence on the self-management of cardiac pain and associated symptoms in women. Seven databases were systematically searched, and the concepts of the Individual and Family Self-Management Theory were used as the framework for data extraction and analysis. Search strategies yielded 22,402 citations, from which 35 qualitative studies were included in a final meta-summary, comprising data from 769 participants, including 437 (57%) women. The available literature focused cardiac pain self-management from a binary sex and gender perspective. Ethnicity was indicated in 19 (54%) studies. Results support individualized intervention strategies that promote goal setting and action planning, management of physical and emotional responses, and social facilitation provided through social support.

6.
Can J Cardiol ; 34(4): 458-467, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29477931

RESUMO

BACKGROUND: Cardiac pain is considered the primary indicator of coronary artery disease (CAD). Existing reviews lack appropriate numbers of women or sex-based subgroup analyses, or both; thus, the benefits of self-management (women with cardiac pain actively participating in their own care and treatment) remain uncertain. METHODS: Using methods described by the Evidence for Policy and Practice Information and Co-ordinating Centre at the Institute of Education, 7 databases were systematically searched to examine and synthesize the evidence on self-management interventions for women with cardiac pain and cardiac pain equivalents, such as fatigue, dyspnea, and exhaustion. RESULTS: Our search yielded 22,402 article titles and abstracts. Of these, 57 randomized controlled trials were included in a final narrative synthesis, comprising data from 13,047 participants, including 5299 (41%) women. Self-management interventions targeting cardiac pain in women compared with a control population reduced (1) cardiac pain frequency and cardiac pain proportion (obstructive and nonobstructive CAD), (2) fatigue at 12 months, and (3) dyspnea at 2 months. There was no evidence of group differences in postprocedural (percutaneous coronary intervention or cardiac surgery) pain. Results indicated that self-management interventions for cardiac pain were more effective if they included a greater proportion of women (standardized mean difference [SMD], -0.01; standard error, 0.003; P = 0.02), goal setting (SMD, -0.26; 95% confidence interval [CI], -0.49 to -0.03), and collaboration/support from health care providers (SMD, -0.57; 95% CI, -1.00 to -0.14). CONCLUSIONS: The results of this review suggest that self-management interventions reduce cardiac pain and cardiac pain equivalents.


Assuntos
Angina Pectoris , Autogestão/métodos , Angina Pectoris/diagnóstico , Angina Pectoris/terapia , Feminino , Humanos , Manejo da Dor/métodos , Medição da Dor/métodos
7.
Eur J Cardiovasc Nurs ; 15(3): e52-9, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-25851233

RESUMO

OBJECTIVE: Prodromal symptoms (PS), indicative of myocardial ischemia, are frequently unrecognized by individuals prior to an acute coronary syndrome (ACS). ACSs are the leading cause of death worldwide. This study describes (1) the prevalence and association of PS with patients' baseline ACS-related acute symptoms of pain intensity and state anxiety and (2) the relationship of PS to co-morbidity. METHODS: An exploratory sub-analysis was performed. Cross sectional data identified prodromal predictors of ACS pain intensity (numeric rating scale 0-10 (NRS)) and state anxiety (Speilberger state-trait anxiety personality inventory (STAI)). ACS patients (n=121) admitted to a community rural emergency department completed the prodromal symptom screening scale (PS-SS) and reported baseline cardiac pain intensity, state, and trait anxiety. RESULTS: Increased ACS pain intensity was associated with PS. Median pain scores were higher by two points for those with prodromal headache, p=0.006, and anxiety, p=0.017, and one point higher for those with sleep disturbances, p=0.012. PS were not associated with state or trait anxiety. Hypertensive individuals were 7.5 times more likely to experience prodromal fatigue prior to their ACS event. CONCLUSION: Results extend current knowledge of the predictive value that prodromal headache, sleep disturbance and anxiety may have on individuals' acute symptom presentation. A prospective, prognostic study is required in order to determine whether PS are predictive of adverse cardiac events and if PS are a stronger predictor of ACS acute symptom presentation, compared with typical ACS-related co-morbidities.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor/diagnóstico , Sintomas Prodrômicos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários
9.
Can J Cardiol ; 24(10): 759-64, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18841254

RESUMO

BACKGROUND: Chronic stable angina (CSA) is a major debilitating health problem in Canada. A paucity of relevant cardiovascular data sets has precluded a detailed examination of the impact of interventions on CSA-related costs and its broader economic burden. OBJECTIVES: As part of a larger clinical trial, the authors sought to determine the short-term impact of a standardized self-management training program on CSA-related costs. A secondary objective was to estimate the total annualized cost of CSA per patient from a societal perspective. METHODS: Pre- and three-month post-test cost data were collected on 117 participants using the Ambulatory Home Care Record. Mean annualized direct, indirect and system-related CSA costs (2003 to 2005) were estimated; total per-patient CSA costs from a societal perspective were calculated as the sum of these costs. RESULTS: The mean (+/- SD) age of participants was 68+/-11 years; 80% were male. The program did not impact costs in the short-term. Direct annual out-of-pocket costs, including money paid for health care, travel to appointments, medication, equipment and home support totaled $3,267. Indirect costs, reflecting the value of all unpaid time spent by those engaged in angina-related care, were $12,963. System costs, including costs paid by public and private insurers, were $2,979. Total estimated annual CSA costs from a societal perspective were $19,209 per patient. CONCLUSIONS: These data suggest that CSA imposes a major economic burden, comparable with other prevalent conditions such as chronic noncancer pain. Advancements in self-management training research are needed to help reduce the economic burden of CSA in Canada.


Assuntos
Angina Pectoris/economia , Efeitos Psicossociais da Doença , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Idoso , Angina Pectoris/terapia , Doença Crônica , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Masculino , Ontário , Estudos Retrospectivos , População Urbana
10.
J Pain Symptom Manage ; 36(2): 126-40, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18395397

RESUMO

Cardiac pain arising from chronic stable angina (CSA) is a cardinal symptom of coronary artery disease and has a major negative impact on health-related quality of life (HRQL), including pain, poor general health status, and inability to self-manage. Current secondary prevention approaches lack adequate scope to address CSA as a multidimensional ischemic and persistent pain problem. This trial evaluated the impact of a low-cost six-week angina psychoeducation program, entitled The Chronic Angina Self-Management Program (CASMP), on HRQL, self-efficacy, and resourcefulness to self-manage anginal pain. One hundred thirty participants were randomized to the CASMP or three-month wait-list usual care; 117 completed the study. Measures were taken at baseline and three months. General HRQL was measured using the Medical Outcomes Study 36-Item Short Form and the disease-specific Seattle Angina Questionnaire (SAQ). Self-efficacy and resourcefulness were measured using the Self-Efficacy Scale and the Self-Control Schedule, respectively. The mean age of participants was 68 years, 80% were male. Analysis of variance of change scores yielded significant improvements in treatment group physical functioning [F=11.75(1,114), P<0.001] and general health [F=10.94(1,114), P=0.001] aspects of generic HRQL. Angina frequency [F=5.57(1,115), P=0.02], angina stability [F=7.37(1,115), P=0.001], and self-efficacy to manage disease [F=8.45(1,115), P=0.004] were also significantly improved at three months. The CASMP did not impact resourcefulness. These data indicate that the CASMP was effective for improving physical functioning, general health, anginal pain symptoms, and self-efficacy to manage pain at three months and provide a basis for long-term evaluation of the program.


Assuntos
Angina Instável/reabilitação , Dor no Peito/prevenção & controle , Educação de Pacientes como Assunto/métodos , Psicoterapia/métodos , Qualidade de Vida , Autocuidado/métodos , Autoeficácia , Idoso , Angina Instável/complicações , Dor no Peito/etiologia , Feminino , Humanos , Masculino , Resultado do Tratamento
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