WeChat-based education and rehabilitation program in unprotected left main coronary artery disease patients after coronary artery bypass grafting: an effective approach in reducing anxiety, depression, loss to follow-up, and improving quality of life.

Chongyi Ma,Lei Zheng,Xiaomeng Zhao,Guorong Li,Fan Fu,Qingfeng Guo,Bo Wang

doi:10.1590/1414-431x202010370

Abstract

This study aimed to investigate the effect of WeChat-based education and rehabilitation program (WERP) on anxiety, depression, health-related quality of life (HRQoL), major adverse cardiac/cerebrovascular events (MACCE)-free survival, and loss to follow-up rate in unprotected left main coronary artery disease (ULMCAD) patients after coronary artery bypass grafting (CABG). In this randomized controlled study, 140 ULMCAD patients who underwent CABG were randomly assigned to WERP group (n=70) or control care (CC) group (n=70). During the 12-month intervention period, anxiety and depression (using hospital anxiety and depression scale (HADS)) and HRQoL (using 12-Item Short-Form Health Survey (SF-12)) were assessed longitudinally. During the total 36-month follow-up period (12-month intervention and 24-month non-intervention periods), MACCE and loss to follow-up were recorded. During the intervention period, HADS-anxiety score at month 9 (M9) (P=0.047) and month 12 (M12) (P=0.034), anxiety rate at M12 (P=0.028), and HADS-D score at M12 (P=0.048) were all reduced in WERP group compared with CC group. As for HRQoL, SF-12 physical component summary score at M9 (P=0.020) and M12 (P=0.010) and SF-12 mental component summary score at M9 (P=0.040) and M12 (P=0.028) were all increased in WERP group compared with CC group. During the total follow-up period, WERP group displayed a trend of longer MACCE-free survival than that in CC group but without statistical significance (P=0.195). Additionally, loss to follow-up rate was attenuated in WERP group compared with CC group (P=0.033). WERP serves as an effective approach in optimizing mental health care and promoting life quality in ULMCAD patients after CABG.

Highlights

The remaining 140 Unprotected left main coronary artery disease (ULMCAD) patients were randomly assigned to control care (CC) group (n=70) or WeChat-based education and rehabilitation program (WERP) group (n=70) in a 1:1 ratio
During the 12month intervention period, HADS-A/D score and SF-12 PCS/MCS score were assessed at M3, M6, month 9 (M9), and month 12 (M12) in both CC and WERP groups
6 patients in CC group and 4 patients in WERP group were lost to follow-up within the intervention period, which resulted in 64 and 66 patients who completed the study intervention in CC group and WERP group, respectively

Summary

Introduction

Unprotected left main coronary artery disease (ULMCAD) represents a highly lethal condition with more than 50% stenosis of the left main coronary artery without patent bypass graft to the left ventricular myocardium [1,2]. Coronary artery bypass grafting (CABG) has been recommended as the standard revascularization procedure in the treatment of ULMCAD patients based on early clinical trials demonstrating a conferred survival benefit [3]. Owing to daily fatigue and cardiac symptoms (such as pain and dyspnea), ULMCAD patients frequently experience psychological distress including anxiety and depression after CABG [4,5]. Anxiety and depression are related to lower compliance with treatment/lifestyle changes, increased risk of major adverse cardiac events, elevated rates of all-cause mortality, and diminished quality of life in ULMCAD patients after CABG [6,7]. Effective psychological and psychopharmacological interventions for attenuating anxiety and depression, promoting functional recovery, as well as improving health-related quality of life (HRQoL) are essential in ULMCAD patients after CABG.

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