Patient Recovery and Transitions After Hospitalization for Acute Cardiac Events

Abstract

Despite increased attention to providing seamless transitions after hospitalization, patients often feel unprepared, lack knowledge, and may be confused by what to expect during recovery at home after a cardiac event. Care transition after hospital discharge could be improved by informing and counseling patients more specifically about expected recovery after a cardiac event. Therefore, an integrative review of research was conducted to evaluate cardiac patients' trajectory of recovery after hospitalization. A total of 61 studies were included in this review. Studies included were those of cardiac patients who had been hospitalized for significant cardiac events and those focused on acute coronary syndrome (n = 18), percutaneous coronary intervention (PCI) (n = 12), cardiac surgery (coronary artery bypass surgery and valve surgery; n = 25), and heart failure (n = 6). Studies included quantitative, mixed-methods, and qualitative designs, with sample sizes ranging from 4 to 2121 participants. Notwithstanding the limitations of this review, findings demonstrated that patients' perceptions of their cardiac event evolved over time from uncertainty, fears, anxiety, and depression, which were often associated with a lack of knowledge of their cardiac condition, to a phase of self-management of their cardiac condition. Furthermore, patterns of commonly occurring symptoms and changes in functioning abilities during recovery after hospitalization were apparent among the different cardiac groups. These findings may be useful to both patients and clinicians to inform them about the recovery trajectory after a cardiac event to improve preparation for the transition from hospital to home.

Symptom Trajectories After an Emergency Department Visit for Potential Acute Coronary Syndrome

“…The findings of this secondary data analysis add support to existing evidence that patients experience ongoing symptoms after an ED visit for potential ACS (Barnason et al, 2012). The analysis also reveals that individuals vary in both their initial symptom severity and rate and direction of change—a finding that has not been previously described in this population.…”

“…This timeframe was chosen because a significant portion of patients are readmitted within 30 days after discharge, and many report symptoms up to six months later (Barnason, Zimmerman, Nieveen, Schulz, & Young, 2012; Vashi et al, 2013). The goals of this exploratory investigation were to increase understanding of these symptom trajectories, generate further testable hypotheses, and inform education for patients and healthcare providers about symptom trajectories after hospital discharge.…”

“…The great majority of patients ruled in and ruled out for ACS are eventually discharged home—either from the ED or from inpatient units—but little is known about their symptoms after discharge (Barnason et al, 2012). This knowledge gap results in periods where patients are undersupported, undereducated, and undertreated (Naylor, Aiken, Kurtzman, Olds, & Hirschman, 2011).…”

Continuity of care after percutaneous coronary intervention: The patient’s perspective across secondary and primary care settings

“…14,18 Development of the interview guide was guided by Haggerty et al’s 6 definition of continuity of care (Box 1). The interview guide was slightly modified after performing two pilot interviews.…”

“…11,12 Furthermore, these studies showed that patients experienced negative relationships with healthcare providers, poor communication and difficulties in progressing through the system, and that they received insufficient information about further policy and follow-up appointments. 9,11–15 It seems that the first weeks after discharge are difficult for patients, and it is important that care is coherent and consistent with their medical and psychosocial needs. 5,16 Few studies have analysed patients’ experiences of continuity of care in a comprehensive manner, and they typically have focused on only one type of continuity or one care level.…”