Effect of Discharge Planning Program on Patient's Outcomes Post Coronary Artery Bypass Graft Surgery

Cardiovascular diseases (CVD) are the main threats to human lives (Benjamin et al., 2018). Around 17.9 million deaths worldwide were attributed to CVD (Benjamin et al., 2018); Which Represents 31 % of the global deaths (Benjamin et al., 2018). Coronary artery disease is one of the CVD. Coronary artery disease prevalence among United State (US) adults aged 20 years and above is 6.3 %. It is responsible for 43.8 % of the deaths worldwide. (Benjamin et al., 2018).

In Jordan, CVD is the leading cause of death. During 2016; 37 % of all deaths among Jordanian population were due to CVD. Coronary Artery Disease is responsible for 18 % of the deaths (Centers of Disease Control [CDC], 2016) Coronary artery diseases currently are managed with medical treatment, percutaneous coronary interventions (PCI) or Coronary artery bypass graft (CABG) surgery (Habib et al., 2015). Coronary artery bypass graft surgery is the indicated choice for multi-vessel coronary disease (Habib et al., 2015). It is defined as a revascularization procedure used for the treatment of CAD. It involves establishing a graft from another vessel of the body to bypass the narrowed coronary artery and restore blood flow to the cardiac muscle (Urden, Stacy, & Lough, 2017).

Even though Coronary Artery Bypass Graft surgery is believed to provide more complete revascularization and leading to improved long term outcomes than PCI (Hillis et al., 2011); the recovery process after hospital discharge might be complicated by the occurrence of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) (Goldfarb et al., 2015). Major Adverse Cardiovascular and Cerebrovascular Events consist of mortality, myocardial infarction (MI), stroke and need for repeat revascularization (Goldfarb et al., 2015). Mortality leads to losing the patient after a major and costly surgery, while; MI, stroke and need for reopening or repeat revascularization leads to patient readmission to the hospital and might end up with increased mortality rate (Goldfarb et al., 2015; Hillis et al., 2011).

Mortality rate after CABG ranges from 1.1% -24 % (Grundeken et al., 2013; Jose et al., 2019; Shah et al., 2019; Wrobel et al., 2015). Among the Jordanian CABG population; all-cause mortality reported 30 day after surgery was 5.9 % in 1046 patients (AlWaqfi, Khader, & Ibrahim, 2012).

The readmission rate of CABG patients within 30 days is seriously high (Feng, White, Gaber-Baylis, Turnbull, & Rong, 2018). More specifically; Feng et al., (2018) reported that 28601 adult CABG patients out of 177229 (16 %) in the united States (US) were readmitted within 30 days (Feng et al., 2018). Another study revealed that more than 60 % of CABG patients readmissions occur within the first week post discharge (Price, Romeiser, Gnerre, Shroyer, & Rosengart, 2013). Several reasons stand behind hospital readmissions after CABG surgery (Mary, 2017; Seifert, 2017). Price et al., (2013) reported that 25% of 13% hospital readmissions after CABG surgery were attributed to cardiac reasons.