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This is a prospective, randomized controlled trial to evaluate the effectiveness of a Technology-Enhanced Continuous Nursing System (TECNS) compared to routine care for patients after coronary artery bypass grafting (CABG). The study aims to determine if the TECNS intervention, which includes digital health tools, personalized tele-rehabilitation, and continuous nursing support, can improve clinical outcomes such as postoperative hemoglobin recovery, reduce long-term major adverse cardiac events (MACE), and enhance patients' quality of life and psychological well-being.
Patients undergoing coronary artery bypass grafting (CABG) face significant challenges during the post-discharge recovery period. The transition from hospital to home often creates a "care gap," where insufficient support and follow-up can lead to suboptimal outcomes, including poor medication adherence, increased complication rates, and diminished quality of life. This study was designed to address this gap by implementing and evaluating a Technology-Enhanced Continuous Nursing System (TECNS). Participants were randomized to receive either the comprehensive TECNS intervention for 6 months post-discharge or standard routine care. The TECNS intervention integrated a dedicated smartphone application for education, a WeChat group for peer and professional support, personalized tele-rehabilitation plans delivered by nurses, and coordination with community health centers. The study hypothesized that this proactive, continuous care model would lead to superior physiological recovery, better long-term clinical outcomes, and improved patient-reported outcomes compared to the traditional, fragmented approach to post-discharge care.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental: Technology-Enhanced Continuous Nursing System (TECNS) Group | Experimental | Patients received a comprehensive, 6-month continuous nursing program post-discharge. This included training on a dedicated smartphone app for educational modules; access to a moderated WeChat group for peer support and health tips; scheduled tele-rehabilitation calls from cardiac nurses for monitoring, education, and personalized guidance; and coordination with community health centers for follow-up. This was in addition to standard in-hospital care. |
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| Active Comparator: Routine Care Group | Active Comparator | Patients received standard institutional postoperative care, including basic discharge education (oral and written summaries on medication, diet, and activity). Post-discharge care consisted of scheduled outpatient follow-up visits at 1 and 3 months post-surgery, without the technology-enhanced continuous support components. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Technology-Enhanced Continuous Nursing System | Behavioral | A multi-faceted behavioral and educational intervention lasting 6 months post-discharge. It utilized a smartphone app, WeChat, tele-monitoring (phone/video calls), and community health partnerships to provide structured education, personalized rehabilitation plans, and continuous professional nursing support. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Hemoglobin (Hb) Level | Change in blood hemoglobin concentration from baseline to 7 days after surgery, measured by laboratory analysis. This assesses the rate of postoperative hematopoietic recovery. | Baseline, Day 7 |
| Major Adverse Cardiac Events (MACE)-Free Survival | The rate of survival free from MACE, defined as a composite of cardiovascular death, non-fatal myocardial infarction, stroke, or unplanned revascularization. | Up to 24 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Red Blood Cell Indices | Change in Mean Corpuscular Volume (MCV), Red Blood Cell Distribution Width (RDW), and Hematocrit (HCT) from baseline. | Baseline, Day 7 |
| Change in Quality of Life (QoL) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The First Hospital of Hebei Medical University | Shijiazhuang | Hebei | 050000 | China |
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| ID | Term |
|---|---|
| D003324 | Coronary Artery Disease |
| ID | Term |
|---|---|
| D003327 | Coronary Disease |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| Routine Postoperative Care | Behavioral | Standard institutional care including standard discharge instructions and routine outpatient follow-up appointments. |
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Change in patient-reported quality of life assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale. The scale ranges from 0 to 100. Higher scores indicate better QoL.
| Baseline, 1 month, 3 months, 6 months |
| Patient Satisfaction | Patient-reported satisfaction with nursing care, assessed using a study-specific questionnaire. Responses are categorized ('Very Satisfied', 'Satisfied', 'Average', 'Dissatisfied'). | 1 month |
| Change in Interleukin-2 (IL-2) Level | Change in serum level of Interleukin-2 (IL-2) from baseline, measured by laboratory analysis. | Baseline, Day 7 |
| Change in Interleukin-6 (IL-6) Level | Change in serum level of Interleukin-6 (IL-6) from baseline, measured by laboratory analysis. | Baseline, Day 7 |
| Change in high-sensitivity C-reactive protein (hs-CRP) Level | Change in serum level of high-sensitivity C-reactive protein (hs-CRP) from baseline, measured by laboratory analysis. | Baseline, Day 7 |
| Change in Anxiety Symptoms | Change in symptoms of anxiety assessed using the Self-Rating Anxiety Scale (SAS). The scale range is 25-100. Lower scores indicate better mental health (less anxiety). | Baseline, 1 month, 3 months, 6 months |
| Change in Depression Symptoms | Change in symptoms of depression assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). The scale range is 0-60. Lower scores indicate better mental health (less depression). | Baseline, 1 month, 3 months, 6 months |
| D001161 |
| Arteriosclerosis |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |