Myocardial infarction (MI) is a common cause of cardiovascular deaths. Education of patients with myocardial infarctions essential to prevent further cardiovascular events and reduce the risk of mortality. The study aimed to evaluate the associations between patients’ readiness for hospital discharge after myocardial infarction, acceptance of illness, social, demographic, and clinical factors. The study used a cross-sectional design and included 102 patients, who were hospitalized for myocardial infarction after percutaneous coronary intervention (PCI). Two questionnaires were used: The Readiness for Hospital Discharge After Myocardial Infarction Scale (RHD-MIS) and Acceptance of Illness Scale (AIS). Low readiness characterized nearly half of patients (47.06%), 27.45% of patients showed an intermediate level of readiness, while 25.49% of patients had high readiness. Readiness for hospital discharge was higher among younger patients, respondents living in relationships, living with a family, with tertiary or secondary education, and professionally active. Acceptance of illness was higher among male patients, respondents living in relationships, and family, with secondary education and professionally active. The AIS score positively correlated with readiness for hospital discharge.
The comprehensive care model after myocardial infarction (CCMI, in Polish: KOS-Zawał) has been in effect continuously since October 2017. Within the bundle of services financed by the Polish National Health Fund (NHF), patients receive a diagnosis, conservative and invasive treatment, early cardiac rehabilitation and follow-up visits for 12 months. The existing model of managing patients after myocardial infarction (MI) implements all crucial aspects of care recommended by the European Society of Cardiology (ESC), emphasised many times. The purpose of this paper was to report and describe the course of the implementation of the unique concept—CCMI model, including the scope of the introduced changes and the implementation and structural evaluation of its effects over the period 2017–2021. Our preliminary study reported that the CCMI programme reduces the risk of patient death in the first year after MI by 29%. Furthermore, the authors point out the strict cause and effect relationship between the cardiovascular disease prevention programme since 2004 as the key instrument for the primary systemic prevention implemented outside the CCMI model.
Funding Acknowledgements Type of funding sources: None. Introduction Disability is defined as functional problems in performing activities of daily living necessary for independent living and reflects the interaction between the individual and the surrounding environment. Disability may affect up to 76% of patients qualified for cardiac surgery. Disabilty as a construct that increases the perioperative risk may contribute to the loss of autonomy, increase dependence on others and reduce the quality of life. In addition, it is associated with longer hospital stays, increased use of healthcare resources, institutionalization and mortality. Purpose Assessment of the relationship between preoperatively assessed disabilty and postoperative morbidity in cardiac surgery patients. Material and Methods The study included 100 patients (60 men, 40 women, mean age 71.69 ± 4.96) scheduled for elective cardiac surgery. The study used a self-designed questionnaire to collect sociodemographic data, an analysis of medical records to collect data on postoperative morbidity, and a standardized tool for disability assessment. In the assessment of disability, the Nagi scale (assessment of difficulty in performing activities such as: pulling or pushing a chair, bending, crouching or kneeling, raising hands above the head, lifting or carrying small objects in the fingers, lifting 5 kg, going up or down stairs, walking 1.5 kg) was used, where significant disability is diagnosed when ≥ 3 points are obtained. The assumed significance level was p < 0.05. Results In the Nagi scale, the study group obtained an average score of M±SD = 3.41±1.83 points before the procedure. Women scored significantly higher on the Nagi scale than men (M±SD = 3.981. ±76 vs. MS±D = 3.03±1.79, p = 0.008). Patients with prolonged respiratory therapy had a significantly higher Nagi score before the procedure than patients without this complication (M±SD = 4.31±1.75 vs. M±SD = 3.04±1.74, p = 0.003). Patients who required hospitalization for more than 14 days before the procedure had a significantly higher score on the Nagi scale than patients without this complication (M±SD = 5.40±1.67 vs. M±SD = 3.31 ±1.79, p = 0.022). Patients with the composite morbidity endpoint had significantly higher Nagi scores before surgery (MS±D = 3.77±1.87 vs. M±SD = 2.88±1.65, p = 0.013). In univariate analysis, the Nagi score (OR: 1.32, 95% CI: 1.04-1.68, p = 0.019) and the Nagi score ≥3 points (OR: 2.96, 95% CI: 1.20-7.28, p = 0.017) were significant predictors of postoperative morbidity. The value of the Nagi scale as a continuous variable (OR: 1.29, 95% CI: 1.02-1.64, p = 0.033) and Nagi ≥3 points (OR: 2.71, 95% CI: 0.48-6.61, p = 0.032) were age- and multimorbidity-independent predictors of postoperative morbidity in the study group. Coclusions. Disabilty identified before the procedure has a negative impact on the incidence of postoperative morbidity in cardiac surgery patients. Assessment of disability before cardiac surgery is important in predicting outcomes.
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