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Title: Randomised controlled trial of a programme to reduce risk factors in patients waiting for coronary artery bypass surgery
Author: Goodman, Helen
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2008
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The thesis is a report of a randomised controlled trial with 188 patients to evaluate a nurseled education and support programme in terms of outcomes, process and context. The 'Fit For Surgery' programme was based on previous studies suggesting substantial benefit in controlling anxiety and risk factors contributing to coronary disease while patients wait for coronary artery bypass surgery. Patients listed for coronary artery bypass surgery with at least one poorly controlled risk factor were randomised to standard care or the intervention which provided lifestyle management counselling, and physical and psychological preparation for surgery in monthly visits to the patients' homes. The trial measured progress from baseline to 3 months after discharge. Primary outcome measurements were anxiety, blood pressure, cholesterol, body mass index and length of stay. Secondary outcomes were quality of life (measured t>y the HAD scale, SF-36 form and Coronary Artery Revascularisation Questionnaire) and complications during admission. Costs of the intervention were calculated. Views of patients and staff were collected by 'Discovery Interviews', a quality improvement tool devised by the NHS Modernisation agency, and focus groups. For both Intervention and Control groups blood pressure and total cholesterol improved (Blood pressure (Control -9.11mmHg (CI -4.89, -13.33); Intervention -13.02mmHg (CI -8.76, 17.29) both p<0.01); total cholesterol (Control -0.20mmoJlI (CI -0.03, -0.37) p=0.02, Intervention -0.18mmolll (CI -0.02, -0.34) p=0.03). However there were no significant differences between the groups in the primary outcome measures at any of the measurement points. Qualitative data suggested the patients appreciated support from the nurses but varied in their understanding of the programme and degree of motivation to improve their health. Cost minimization analysis showed the total costs were less in the intervention group due to less in-patient admissions during the waiting period (Total costs ��?���£9898 (3234) v 11427 (5400), CI-2813, -244; P= 0.02).
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available