Optimizing Patient Expectations: Cardiac Surgery Outcomes

Disability and quality of life 6 months after coronary artery bypass grafting (CABG) were found to be significantly improved by a brief intervention focusing on patient expectations before surgery (PSY-HEART-I study). However, to generalize the results and their implications for the healthcare system, a large multicenter experiment was needed to explore the therapeutic value of such an intervention. The purpose of the PSY-HEART-II trial was to determine whether preoperative psychological intervention to adjust patient expectations (EXPECT) can improve outcomes 6 months after coronary artery bypass graft (CABG) surgery (with or without valve replacement cardiac). The standard of care (SOC) and an emotional support intervention not focusing on expectations will be used as benchmarks for the EXPECT (SUPPORT) study. N equal to 567 patients undergoing CABG will be randomly assigned to receive either SOC alone, SOC and EXPECT, or SOC and SUPPORT in a prospective, multicenter, randomized, 3-arm controlled trial (RCT). To compare EXPECT and SOC, patients will be randomly assigned to EXPECT or SUPPORT, with a fixed imbalance ratio of 3:1:1. Both psychological treatments involve 2 in-person appointments (each lasting 50 minutes), 2 telephone consultations (each lasting 20 minutes) in the week before surgery and 1 follow-up telephone consultation 6 weeks after the operation. Baseline assessments will take place between 3 and 10 days before surgery, on the day of surgery itself, after 4 to 6 days and at 6 months. Disability due to disease at 6 months after surgery will be the primary focus of the study. Secondary outcomes include patients’ hopes, patients’ perceptions of their own condition, patients’ quality of life, their hospital stays, and their blood test values ​​(eg, parameters inflammatory diseases such as IL-6, IL-8, CRP). With enough participants, this massive multicenter experiment could confirm and generalize the encouraging results of the PSY-HEART-I trial for the routine management of cardiac surgery patients, thus prompting adjustments to treatment guidelines in cardiac surgery. .

Source: sciencedirect.com/science/article/pii/S0002870322001612