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"Prehabilitation" prior to CABG surgery improves physical functioning and depression.

Furze G, Dumville JC, Miles JN, Irvine K, Thompson DR, Lewin RJ - Int. J. Cardiol. (2008)

Bottom Line: There were significant differences in depression (difference=7.79, p=0.008, 95% CI=2.04-13.54), physical functioning (difference=0.82, p=0.001, 95%CI=0.34-1.3) and cardiac misconceptions (difference=2.56, p<0.001, 95%CI=1.64-3.48) in favour of the HeartOp Programme.The HeartOp Programme was found to have an Incremental Cost Effectiveness Ratio (ICER) of pound 288.83 per Quality-Adjusted Life Year.Nurse counselling with the HeartOp Programme reduces depression and cardiac misconceptions and improves physical functioning before bypass surgery significantly more than nurse counselling alone and meets the accepted criteria for cost efficacy.

View Article: PubMed Central - PubMed

Affiliation: British Heart Foundation Care & Education Research Group, Department of Health Sciences, University of York, York, UK. gf107@york.ac.uk

ABSTRACT

Background: Many patients demonstrate psychological distress and reduced physical activity before coronary artery bypass graft surgery (CABG). Here we evaluated the addition of a brief, cognitive-behavioural intervention (the HeartOp Programme) to routine nurse counselling for people waiting for CABG surgery.

Methods: Randomised controlled trial comparing nurse counselling with the HeartOp programme to routine nurse counselling in 204 patients awaiting first time elective CABG. Primary outcome measures were: anxiety and length of hospital stay; secondary outcome measures were: depression, physical functioning, cardiac misconceptions and cost utility. Measures were collected prior to randomisation and after 8 weeks of their intervention prior to surgery, excepting length of hospital stay which was collected after discharge following surgery.

Results: 100 patients were randomised to intervention, 104 to control. At follow-up there were no differences in anxiety or length of hospital stay. There were significant differences in depression (difference=7.79, p=0.008, 95% CI=2.04-13.54), physical functioning (difference=0.82, p=0.001, 95%CI=0.34-1.3) and cardiac misconceptions (difference=2.56, p<0.001, 95%CI=1.64-3.48) in favour of the HeartOp Programme. The only difference to be maintained following surgery was in cardiac misconceptions. The HeartOp Programme was found to have an Incremental Cost Effectiveness Ratio (ICER) of pound 288.83 per Quality-Adjusted Life Year.

Conclusions: Nurse counselling with the HeartOp Programme reduces depression and cardiac misconceptions and improves physical functioning before bypass surgery significantly more than nurse counselling alone and meets the accepted criteria for cost efficacy.

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Related in: MedlinePlus

Cost effectiveness acceptability curve.
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fig2: Cost effectiveness acceptability curve.

Mentions: Data indicate that the intervention produced, on average, greater QALYs of 0.006 and that the intervention cost had slightly increased cost implications of £1.73. This corresponds to an ICER (i.e. differential cost/differential QALY) of £288.33. From the 95% credibility intervals (CrI) it can be seen that there is uncertainty around this estimate, however, the cost effectiveness acceptability curve (Fig. 2) suggests there is > 90% probability that a cost per QALY of < 30 k is achieved, thus the intervention is very likely to be considered cost effective in terms of £ per QALY.


"Prehabilitation" prior to CABG surgery improves physical functioning and depression.

Furze G, Dumville JC, Miles JN, Irvine K, Thompson DR, Lewin RJ - Int. J. Cardiol. (2008)

Cost effectiveness acceptability curve.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2643012&req=5

fig2: Cost effectiveness acceptability curve.
Mentions: Data indicate that the intervention produced, on average, greater QALYs of 0.006 and that the intervention cost had slightly increased cost implications of £1.73. This corresponds to an ICER (i.e. differential cost/differential QALY) of £288.33. From the 95% credibility intervals (CrI) it can be seen that there is uncertainty around this estimate, however, the cost effectiveness acceptability curve (Fig. 2) suggests there is > 90% probability that a cost per QALY of < 30 k is achieved, thus the intervention is very likely to be considered cost effective in terms of £ per QALY.

Bottom Line: There were significant differences in depression (difference=7.79, p=0.008, 95% CI=2.04-13.54), physical functioning (difference=0.82, p=0.001, 95%CI=0.34-1.3) and cardiac misconceptions (difference=2.56, p<0.001, 95%CI=1.64-3.48) in favour of the HeartOp Programme.The HeartOp Programme was found to have an Incremental Cost Effectiveness Ratio (ICER) of pound 288.83 per Quality-Adjusted Life Year.Nurse counselling with the HeartOp Programme reduces depression and cardiac misconceptions and improves physical functioning before bypass surgery significantly more than nurse counselling alone and meets the accepted criteria for cost efficacy.

View Article: PubMed Central - PubMed

Affiliation: British Heart Foundation Care & Education Research Group, Department of Health Sciences, University of York, York, UK. gf107@york.ac.uk

ABSTRACT

Background: Many patients demonstrate psychological distress and reduced physical activity before coronary artery bypass graft surgery (CABG). Here we evaluated the addition of a brief, cognitive-behavioural intervention (the HeartOp Programme) to routine nurse counselling for people waiting for CABG surgery.

Methods: Randomised controlled trial comparing nurse counselling with the HeartOp programme to routine nurse counselling in 204 patients awaiting first time elective CABG. Primary outcome measures were: anxiety and length of hospital stay; secondary outcome measures were: depression, physical functioning, cardiac misconceptions and cost utility. Measures were collected prior to randomisation and after 8 weeks of their intervention prior to surgery, excepting length of hospital stay which was collected after discharge following surgery.

Results: 100 patients were randomised to intervention, 104 to control. At follow-up there were no differences in anxiety or length of hospital stay. There were significant differences in depression (difference=7.79, p=0.008, 95% CI=2.04-13.54), physical functioning (difference=0.82, p=0.001, 95%CI=0.34-1.3) and cardiac misconceptions (difference=2.56, p<0.001, 95%CI=1.64-3.48) in favour of the HeartOp Programme. The only difference to be maintained following surgery was in cardiac misconceptions. The HeartOp Programme was found to have an Incremental Cost Effectiveness Ratio (ICER) of pound 288.83 per Quality-Adjusted Life Year.

Conclusions: Nurse counselling with the HeartOp Programme reduces depression and cardiac misconceptions and improves physical functioning before bypass surgery significantly more than nurse counselling alone and meets the accepted criteria for cost efficacy.

Show MeSH
Related in: MedlinePlus