Effect Of Comprehensive Nursing Intervention Based On Comprehensive Geriatric Assessment In Cardiac Rehabilitation Of Hospitalized Elderly Patients With Coronary Heart Disease

Objective Comprehensive geriatric assessment (CGA) was applied in clinical care forhospitalized elderly patients with coronary heart disease (CHD), in order to timely detectpotential problems in these elderly patients and to evaluate the significance of CGA incardiac rehabilitation.Methods All143CHD patients admitted by Tangshan People’s Hospital from June2012to June2013were selected, and divided them into a CGA group (74cases) and acontrol group (69cases) by randomization combind with the principle of the unbalancedsmallest index, The control group received cardiology specialist care only, and the CGAreceived systemic CGA nursing intervention in addition to cardiology specialist care. Atdischarge and after6months, the efficacy of CGA nursing intervention was evaluated inthe following four respects:1, health status of the patients that was evaluated by patientsquality of life according to the “Chinese questionnaire of quality of life in patients withcardiovascular diseases”(CQQC);2, clinical indexes including rate of adverse cardiacincidences and up-to-standard ratio of risk factors of CHD after treatment;3, behaviorsthat was evaluated by the subjective response of the patients to the disease according tothe “medical coping modes questionnaire”(MCMQ); and4, services that were evaluatedby satisfaction of the patients, duration and cost of hospitalization, and utilization ofhealth care resources (including times of multi-disciplinary consultation, rate ofadmission by emergency department and hospitalization after relapse after6months.).Statistical analyses were performed with SPSS20.0software package, and data werepresented as x±s. χ2test was performed for count data and t test for measurement data.Results1CGA assessment results75.7%of the74patients of CGA group showedtwo or more types of geriatric syndromes or age-related problems.2The quality of lifeand medical coping modes condition of the two groups of patients The two groups ofpatients had significantly differences compared to the norm,(P<0.05or P<0.01).3Evaluation of the health status of the two groups of patients CQQC score of the twogroups of patients showed no significant difference before the intervention (P>0.05), Thecontrol group showed improvements in physical strength, medical condition, total scoreof the CQQC index after intervention (P<0.05), The CGA group showed improvementsin total score, physical strength, illness, medical condition, general life, social psychology,working relationships after intervention (P<0.01), at6months after discharge showedsignificant differences in all scores between the two groups (P<0.01or P<0.05).4Evaluation of the clinical indexes the CGA group showed significantly lower rate ofnocturnal angina or precordial discomfort during hospitalization between the two groups,and decreased number of cases throughout the day (P<0.01); the control group also showed higher rate of other adverse cardiac events (P<0.05); the two groups showed nosignificances upon admission in up-to-standard ratio of blood pressure, low densitylipoprotein Cholesterol, fasting blood glucose, glycosylated hemoglobin, body massindexes, smoking cessation, and rehabilitation exercise (P>0.05). Upon discharge, theCGA group showed significantly improved up-to-standard ratio of blood pressure, lowdensity lipoprotein Cholesterol, rehabilitation exercise (P<0.05), At6months afterdischarge, the CGA group showed more significantly improved up-to-standard ratio of allthe risk factors (P<0.01or P<0.05), except body mass index (P>0.05).5Assessment ofbehavior of the two groups of patients MCMQ score of the two groups of patientsshowed no significant difference before the intervention (P>0.05). The control groupshowed decreased score of avoidance and surrender after intervention (P<0.05or P<0.01).The CGA group showed decreased score of avoidance and surrender, and increased scoreof positive coping after intervention (P<0.01). At6months after discharge showedsignificant differences in the scores of avoidance and positive coping (P<0.01), but nosignificant difference was detected in the score of surrender (P>0.05) between the twogroups.6Evaluation of medical services The CGA group showed higher level ofsatisfaction with treatment, and nursing service during and after hospitalization comparedto the control group (P<0.01); The CGA group showed significantly shortened CCUhospitalization and total hospitalization (P<0.01or P<0.05); but no significant differencewas detected in total hospitalization cost (P>0.05); the CGA group received significantlymore multi-disciplinary consultations (P<0.01), and had lower rate of emergencydepartment admission and recurrence hospitalization (P<0.05).Conclusion Application of comprehensive nursing intervention based on CGA inclinical practice can more comprehensively discover potential geriatric syndrome or age-related problems in elderly CHD patients; improve positive coping of the elderly CHDpatients. reduce adverse cardiac events in the elderly CHD patients, and can activelycontrol risk factors of CHD. improve quality of life of the elderly CHD patients; improveelderly CHD patients’ satisfaction with treatment and nursing services, promotemultidisciplinary consultation, shorten hospitalization, and reduce rate of emergencydepartment admission and recurrence hospitalization.