Effects of an intervention on health behaviors of older coronary artery bypass (CAB) patients

Kummel, Maika; Vahlberg, Tero; Ojanlatva, Ansa; Kärki, Rauno; T, Mattila; Kivelä, Sirkka‐Liisa

doi:10.1016/j.archger.2007.04.003

Cited by 27 publications

(73 citation statements)

References 37 publications

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“…Of the 147 invited, 125 (85%) agreed to participate and 98 (78%) completed baseline and final follow ups. Kummel and colleagues [50] screened 449 patients scheduled for cardio artery bypass at a single hospital over a 3.5 year period. Of those, 38% ( n = 173) met inclusion criteria (≥65 years old and scheduled for elective surgery).…”

Section: Resultsmentioning

confidence: 99%

“…All four studies assessed alcohol use at baseline and targeted alcohol use in an intervention. Only two studies reported alcohol use outcomes [50,52] and a third [51] provided de‐identified alcohol use data for this review (see Table ). Overall, findings were mixed.…”

Section: Resultsmentioning

confidence: 99%

“…Average daily alcohol use fell from 70 g day −1 at baseline to 26 g day −1 in the entire sample, a 63% reduction (natural log transformed, t = 25.6; P < 0.001), but between-group comparisons were not significant. In contrast, Kummel and colleagues [50] reported a significant time by group interaction (P < 0.001), such that the intervention group was more likely to report 'no drinking' at the 3 month follow up relative to baseline, odds ratio (OR) = 2.2, 95% confidence interval (95% CI) [1.5, 3.3] than the control group OR = 1.3, 95% CI [1.1,…”

Section: Study Outcomesmentioning

confidence: 97%

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A systematic review of behavioural interventions to reduce preoperative alcohol use

Fernandez

Claborn

Borsari

2015

Drug and Alcohol Review

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Issues Preoperative alcohol use is associated with an increase in postoperative morbidity and mortality. Short-term abstinence prior to elective surgery has been shown to reduce postoperative risks. Therefore, behavioural intervention (BI) targeting risky drinking may have significant utility in preventing surgical complications. Approach The literature was systematically reviewed to identify the scope and outcomes of BIs aiming to reduce alcohol use in risky drinkers before they underwent surgery. Five databases were searched using PRISMA criteria. Of 1243 studies identified, four met pre-established inclusion criteria: (i) implementation of a BI prior to an elective surgery; (ii) the BI-targeted alcohol use among risky drinkers; and (iii) printed in English. Key Findings Two studies indicated significant reductions in alcohol use at follow ups, and one study demonstrated reductions in postoperative risks. These findings are encouraging, but in light of methodological limitations, the efficacy of preoperative BIs for risky drinking could not be determined. Implications Future efforts to screen and implement BIs addressing alcohol use in preoperative patients should carefully define risky drinking, allow ample time for recruitment prior to surgery, implement empirically supported interventions, examine the impact of relevant covariates, and consider the statistical power needed to detect change in postoperative complications. Conclusion Given the strong link between preoperative alcohol use and postoperative risks, additional research on preoperative BIs is critically needed. Existing research suggests several promising directions for research that may enhance future intervention efforts with this high-risk population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Outcomesmentioning

confidence: 97%

See 1 more Smart Citation

A systematic review of behavioural interventions to reduce preoperative alcohol use

Fernandez

Claborn

Borsari

2015

Drug and Alcohol Review

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“…Kummel et al 100 conducted a RCT to assess the effects of guidance and counselling delivered in individual and group sessions on health behaviours in older (> 65 years) coronary artery bypass patients. Patients received one group session in the preoperative period and four sessions postoperatively.…”

Section: Behavioural Interventions In the Preoperative Periodmentioning

confidence: 99%

“…They pointed to difficulties in recruitment across the trials. Specifically, the studies by Shourie et al, 95 McHugh et al 98 and Kummel et al 100 took between 15 months and 3.5 years to recruit 117-136 participants. These issues were further exacerbated by the fact that rates of risky drinking in participants recruited to multimodal trials were low.…”

Section: Behavioural Interventions In the Preoperative Periodmentioning

confidence: 99%

Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT

Snowden

Lynch

Avery

et al. 2020

Health Technol Assess

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Background Heavy alcohol consumption is associated with an increased risk of postoperative complications and extended hospital stay. Alcohol consumption therefore represents a modifiable risk factor for surgical outcomes. Brief behavioural interventions have been shown to be effective in reducing alcohol consumption among increased risk and risky drinkers in other health-care settings and may offer a method of addressing preoperative alcohol consumption. Objectives To investigate the feasibility of introducing a screening process to assess adult preoperative drinking levels and to deliver a brief behavioural intervention adapted for the target population group. To conduct a two-arm (brief behavioural intervention plus standard preoperative care vs. standard preoperative care alone), multicentre, pilot randomised controlled trial to assess the feasibility of proceeding to a definitive trial. To conduct focus groups and a national web-based survey to establish current treatment as usual for alcohol screening and intervention in preoperative assessment. Design A single-centre, qualitative, feasibility study was followed by a multicentre, two-arm (brief behavioural intervention vs. treatment as usual), individually randomised controlled pilot trial with an embedded qualitative process evaluation. Focus groups and a quantitative survey were employed to characterise treatment as usual in preoperative assessment. Setting The feasibility study took place at a secondary care hospital in the north-east of England. The pilot trial was conducted at three large secondary care centres in the north-east of England. Participants Nine health-care professionals and 15 patients (mean age 70.5 years, 86.7% male) participated in the feasibility study. Eleven health-care professionals and 68 patients (mean age 66.2 years, 80.9% male) participated in the pilot randomised trial. An additional 19 health-care professionals were recruited to one of three focus groups, while 62 completed an electronic survey to characterise treatment as usual. Interventions The brief behavioural intervention comprised two sessions. The first session, delivered face to face in the preoperative assessment clinic, involved 5 minutes of structured brief advice followed by 15–20 minutes of behaviour change counselling, including goal-setting, problem-solving and identifying sources of social support. The second session, an optional booster, took place approximately 1 week before surgery and offered the opportunity to assess progress and boost self-efficacy. Main outcome measures Feasibility was assessed using rates of eligibility, recruitment and retention. The progression criteria for a definitive trial were recruitment of ≥ 40% of eligible patients and retention of ≥ 70% at 6-month follow-up. Acceptability was assessed using themes identified in qualitative data. Results The initial recruitment of eligible patients was low but improved with the optimisation of recruitment processes. The recruitment of eligible participants to the pilot trial (34%) fell short of the progression criteria but was mitigated by very high retention (96%) at the 6-month follow-up. Multimethod analyses identified the methods as acceptable to the patients and professionals involved and offers recommendations of ways to further improve recruitment. Conclusions The evidence supports the feasibility of a definitive trial to assess the effectiveness of brief behavioural intervention in reducing preoperative alcohol consumption and for secondary outcomes of surgical complications if recommendations for further improvements are adopted. Trial registration Current Controlled Trials ISRCTN36257982. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 12. See the National Institute for Health Research Journals Library website for further project information.

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Reduced or modified dietary fat for preventing cardiovascular disease

Hooper

Summerbell

Thompson

et al. 2011

Cochrane Database of Systematic Reviews

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Background Reduction and modification of dietary fats have differing effects on cardiovascular risk factors (such as serum cholesterol), but their effects on important health outcomes are less clear. Objectives To assess the effect of reduction and/or modification of dietary fats on mortality, cardiovascular mortality, cardiovascular morbidity and individual outcomes including myocardial infarction, stroke and cancer diagnoses in randomised clinical trials of at least 6 months duration. Search methods For this review update, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, were searched through to June 2010. References of Included studies and reviews were also checked. Selection criteria Trials fulfilled the following criteria: 1) randomised with appropriate control group, 2) intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions), 3) not multi factorial, 4) adult humans with or without cardiovascular disease, 5) intervention at least six months, 6) mortality or cardiovascular morbidity data available. Data collection and analysis Participant numbers experiencing health outcomes in each arm were extracted independently in duplicate and random effects meta-analyses, meta-regression, sub-grouping, sensitivity analyses and funnel plots were performed. Main results This updated review suggested that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14% (RR 0.86, 95% CI 0.77 to 0.96, 24 comparisons, 65,508 participants of whom 7% had a cardiovascular event, I2 50%). Subgrouping suggested that this reduction in cardiovascular events was seen in studies of fat modification (not reduction - which related directly to the degree of effect on serum total and LDL cholesterol and triglycerides), of at least two years duration and in studies of men (not of women). There were no clear effects of dietary fat changes on total mortality (RR 0.98, 95% CI 0.93 to 1.04, 71,790 participants) or cardiovascular mortality (RR 0.94, 95% CI 0.85 to 1.04, 65,978 participants). This did not alter with sub-grouping or sensitivity analysis. Few studies compared reduced with modified fat diets, so direct comparison was not possible. Authors’ conclusions The findings are suggestive of a small but potentially important reduction in cardiovascular risk on modification of dietary fat, but not reduction of total fat, in longer trials. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates. The ideal type of unsaturated fat is unclear.

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Effects of an intervention on health behaviors of older coronary artery bypass (CAB) patients

Cited by 27 publications

References 37 publications

A systematic review of behavioural interventions to reduce preoperative alcohol use

A systematic review of behavioural interventions to reduce preoperative alcohol use

Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT

Reduced or modified dietary fat for preventing cardiovascular disease

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