Skip to main content
Download PDF

Educational approaches for patients with heart surgery: a systematic review of main features and effects

BMC Cardiovascular Disorders volume 22, Article number: 292 (2022) Cite this article

Abstract

Introduction

Patients who undergo heart surgery are exposed to mental and physical difficulties after discharge from hospital. They often need support and follow-up after discharge. The use of educational approaches or solutions before or after heart surgery can increase patients' knowledge on the post-operative complications and self-care. The main purpose of this systematic review is to determine the applications of educational approaches and investigate the effects of these approaches on patients with heart surgery.

Method and materiel

A thorough search was conducted in Medline (through PubMed), Scopus, ISI web of science to select related articles published between 2011 and May 2022. All of the retrieved papers were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

Results

A total of 29 articles were obtained from the search, which included in this systematic review after being assessed based on inclusion and exclusion criteria. Most of the articles (n = 10, 34.48%) had been conducted in Canada and Iran, with the most significant number published in 2016. Out of 29 studies, 23 were experimental studies, and six were observational-analytical studies. The number of participants in the studies ranged from 11 to 600 (IQR1: 57.5, median: 88, IQR3: 190). In 28 (96.55%) studies, the educational approaches had a significant effect on clinical, economic or patient-reported outcomes. The greatest effect reported by the studies was related to clinical outcomes such as patient care improvement or change in clinical practice. The most effects in the patient-reported outcomes were related to improving patient satisfaction and patient knowledge. In terms of global rating scores, 17.24% of the included studies were considered as weak, 20.68% as moderate, and 62.06% as strong.

Conclusion

The results of systematic review showed that the use of educational approaches by patients before and after heart surgery can have significant effects on reducing stress and financial burden, and increasing the quality of care and level of knowledge in patients.

Peer Review reports

Introduction

Cardiovascular surgery, also called cardiac surgery or heart surgery, represents any surgical procedure that involves heart or blood vessels that carry blood to and from the heart [1]. These procedures are common in people who have heart disease or had a heart attack, stroke, or blood clot, and also those who are at high risk for developing these problems [2]. There are many types of heart surgery. The National Heart, Lung, and Blood Institute outline the most common coronary surgical procedures, which include Coronary Artery Bypass Grafting (CABG), heart valve repair or replacement, insertion of a pacemaker or an Implantable Cardioverter-Defibrillator (ICD), maze surgery, aneurysm repair, heart transplant, and insertion of Ventricular Assist Device (VAD) or Total Artificial Heart (TAH) [3]. CABG, also called coronary artery bypass, coronary bypass, or bypass surgery, is the most common type of heart surgery, so that more than 300,000 people have successful bypass surgery in the United States each year [4]. The high prevalence of these surgeries has many economic and medical consequences in most countries [5]. However, over a quarter of all CABG and/or VR patients are readmitted to hospitals with postoperative complications during the first three months of recovery. A possible explanation for developing postoperative complications during the recovery period is poor self-care behavior of patients [6].

Patient education is a crucial health intervention to encourage self-care behavior, but it may often lack the required effectiveness [7]. Remarkably, the dose, type, and timing of educational intervention may not be optimal in promoting self-care behaviors, which results in the onset of complications and increased hospitalizations that reduce health-related quality of life [8, 9].

The treatment team prescribes various measures that patients should perform and follow before and after heart surgery. Therefore, these patients need a comprehensive and robust education system to provide them with accurate and practical knowledge on actions they ought to undertake [8,9,10]. Nevertheless, previous studies and expert opinions indicate that despite the establishment of patient education systems, patients often do not correctly participate in the treatment and care, and also do not perform the actions required for their recovery [11]. These and similar issues are among the many challenges in this area that indicate the potential for systemic failures, which need to be addressed [12]. Numerous studies in patient training have shown that education related to patient health increases satisfaction and reduces anxiety and length of hospital stay [13, 14]. Accordingly, a thorough study of current educational systems or the development of a comprehensive system for patients after heart surgery is something that may not receive much attention in medical centers, but the need for such system is evident for these patients [10, 15].

Educational approaches are widely applied in many countries for training patients with heart surgery, and some papers have shown its clinical benefits [10, 14, 16] and positive effects on the survival of patients. The format of patient education differs depending on the degree of standardization and individualization [17, 18]. Different approaches and technologies can be used to educate patients after heart surgery. Technologies such as video resources, virtual reality-based environments, and educational media such as CDs, DVDs, and others are widespread in today's society. In addition to these materials, patients can use other sources such as electronic booklets and brochures [9, 19]. Therefore, a comprehensive study is needed to determine the effectiveness and characteristics of educational approaches or technologies used for education of patients with heart surgery.

Material and methods

Research question

- Has the use of educational approaches or technologies been effective in training patients with heart surgery?

- What are the characteristics of interventions used to educate patients with heart surgery?

Search strategy and study selection

In this study, we conducted a systematic literature review of educational approaches or technologies used for training patients with heart surgery, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist (PRISMA) [20]. Major scientific databases, including Web of Science, Medline (through PubMed), and Scopus were searched systematically, using keywords such as “patient education” and “heart surgery”. Consequentially, related articles published between January 1, 2011 and 21 May, 2022, were retrieved. After removing duplicates, titles and abstracts of retrieved articles, the remaining articles were reviewed by three authors (SR, NR and LS) independently based on inclusion criteria. Several titles and abstracts were also reviewed randomly by LS. In the next stage, full-text screening was carried out. The full texts of related citations were also retrieved and reviewed by three authors based on inclusion and exclusion criteria. Through a full-text review, the final decision was made by LS and BM if there was a disagreement between the authors in regard to the selection of eligible studies. A combination of Medical Subject Headings (MeSH) keywords and terms were used in the search strategy (Table 1).

Table 1 Keywords and search strategy for PubMed database
Full size table

Criteria used for the selection of articles

Studies with the following inclusion and exclusion criteria were included in this review.

Inclusion criteria

The inclusion criteria for the articles are presented in Fig. 1.

Fig. 1
figure 1

Inclusion criteria in this review

Full size image

Exclusion criteria

Articles were excluded if they met the following criteria:

  • Studies published in non- English language.

  • Studies that were not original research (such as book chapters, letters to the editor, reviews or meta-analysis, short briefs, reports and commentaries).

  • Studies that did not examine the impact of educational technologies or approaches on patients.

  • Studies that their full text was not available.

Data extraction

A form in Excel was designed to extract data from included articles. Some classifications were used to classify and analyze the included papers. This classification comprised of general information and specific details. General information included author’s names, publication date, country and journal’s name. Specific information included number of participants, mean age, gender, study participants, intervention group (I), comparison (C) group, study design, content of patient education and theory, applied intervention, effectiveness, main finding, and key outcome.

Data analysis

In order to describe and compare the articles’ results, a narrative synthesis was applied, but meta-analysis was not done due to the diversity of outcomes. We classified outcomes into three main categories of clinical, economical, and patient-reported outcomes. The effect of educational materials on patients with heart surgery was summarized based on three categories: Positive without statistical argument, Positive (statistically significant), No effect (not statistically significant).

Risk of bias and quality assessment

For risk of bias appraisal and quality assessment, we used The Effective Public Health Practice Project (EPHPP) tool to evaluate the quality of selected articles. This tool was preferred because of its ability to evaluate the quality of various quantitative studies related to public health issues or the use of technology in the health industry. In each study, the risk of bias was reckoned for six components; (1) selection bias; (2) study design; (3) confounders; (4) blinding; (5) data collection method; and (6) withdrawals and dropouts [21]. These six components were ranked as strong, moderate, and weak on the three-point Likert scale. Overall methodological quality is rated as weak (two or more poor ranking of individual scale), moderate (one weak individual scale rating), and strong (no weak scale rating). For bias and quality assessment, two authors (SR and NR) investigated each paper, and any disagreements were resolved by discussion with LS and MZ.

Results

Earlier searches in various scientific databases yielded 1878 studies. After duplicate removal, 1014 citations were remained, from which 921 were omitted due to their irrelevancy in the abstract and titles screening stage. After reviewing the full-text of the related citations and applying the exclusion and inclusion criteria, 29 studies were included in this systematic review. The flow diagram related to the identification of eligible articles is shown in Fig. 2. It should be noted that a summary of the key results of papers is described in Table 2 based on the predefined classification elements.

Fig. 2
figure 2

The PRISMA diagram for the records search and study selection

Full size image
Table 2 General characteristics of the included studies (N = 29)
Full size table

Study characteristics

All selected papers that met the inclusion and exclusion criteria had been published in 27 reputable journals. All the names of journals are listed in Table 3, based on their frequency and quartile. Notably, 23 (79.31%) included investigations were published in top quartile one journals. It should be noted that the oldest and newest papers had been published in 2013 and 2021, respectively. The distribution of papers based on publication year is depicted in Fig. 3. As seen in the figure, the largest number of articles (n = 7, 24.13%) had been published in 2016.

Table 3 Distribution of journals by quartile and frequencies
Full size table
Fig. 3
figure 3

The distribution of papers by publications year

Full size image

The distribution of articles based on the countries

The selected papers had been published in 14 countries. The distribution of studies based on country is shown in Fig. 4, based on the worldwide map. As it turns out, Iran and Canada had the highest frequency (n = 10, 34.48%) compared to other countries.

Fig. 4
figure 4

The distribution of papers by countries

Full size image

Distribution of papers based on sample size and type of studies

The number of participants in the studies ranged from 11 to 600 (IQR1: 57.5, median: 88, IQR3: 190). It should be noted that the study design was mostly experimental in the form of Randomized Controlled Trial (RCT), (n = 18, 62.06%). The distribution of studies based on the study design and type is shown in Table 4.

Table 4 Distribution of papers based on study design
Full size table

Distribution of papers based on type of applied materials

In the selected studies, different technologies and educational contexts had been used. The distribution of articles based on the type of applied approaches is shown in Fig. 5. As can be seen in the figure, booklet (electronic booklets), telephone and video resources had been the most widely used educational resources.

Fig. 5
figure 5

Distribution of articles based on the type of used solutions

Full size image

Effectiveness of educational interventions

The effectiveness of educational interventions on patients with heart surgery was summarized based on three categories:

  • No effect (not statistically significant)

  • Positive without statistical argument

  • Positive with statistically significant

As can be seen, in the 22 (75.86%) studies, the employed educational interventions had a statistically significant effect on key outcomes such as increasing the level of knowledge of patients, reducing the length of hospital stay, increasing the level of satisfaction of patients and their families, and so on. Notably, in six examinations (20.68%), the applied educational approaches had positive effects on above-mentioned measures without statistical argument. In one study, the educational platform provided to patients did not affect the quality of care and patients' level of knowledge. Table 5 lists the key factors along with their effectiveness.

Table 5 Effects of educational interventions on key factors
Full size table

Methodological quality assessment

The appraisal of qualities and risk of bias is shown in Fig. 6. According to the rating, 23 (79.31%) studies were strong in terms of cofounders and drop-out. Most studies (n = 19, 65.51%) were strong in terms of study design, and data collection (n = 19, 65.51%). Based on the global rating scores, 62.06% of the investigations were considered strong, 20.68% were considered moderate, and 17.24% were considered weak. Due to the nature of the interventions, which were educational approaches for patients after heart surgery, blinding of participants was not possible in most studies, but in some studies, blinding was performed as an evaluator.

Fig. 6
figure 6

Risk of bias appraisal and quality assessment

Full size image

Discussion

Based on this review, educational approaches have the capacity and potential for self-monitoring and effective treatment of patients. In this systematic review, 29 papers (23 experimental and six observational-analytical) were reviewed in terms of the effects of educational interventions on patients with heart surgery.

These papers assessed a wide range of outcomes related to educational technologies, which were categorized into three main categories of patient-reported measures, clinical outcomes and economical outcomes. In general, most of the studies (28/29, 96.55%) had a significant impact on key outcomes such as improving the quality of care. In contrast, only one study did not report the intervention as effective.

Two of the most important consequences of educational platforms include reducing the level of anxiety and stress of patients after heart surgery and improving the care process [44]. Increasing the level of knowledge and awareness of patients after surgery such as heart surgery leads to changes in behavioral patterns, health and lifestyle [45]. Consequently, patient education is a structured, individual, and systematic process that assesses and transmits information to patients and their families that changes their health behavior and promote their well-being status [46]. The use of appropriate training technologies also reduces the cost of treatment and follow-up of individuals, and leads to a reduction in the workload of medical staff and care organizations [47]. Due to the progress of silent diseases, patient education has slowly become a significant concern, and hospitals and medical centers want to participate in the implementation of better education for patients and their families, and use the best emerging and advanced technologies for this purpose [9]. The use of educational approaches to educate patients after or before heart surgery has become common in recent years. Based on the results of selected studies, people who were trained both before and after heart surgery had significantly higher levels of preoperative knowledge than those who received training only after operation [48].

Studies by Kim et al. and Liu et al. distinguished the anxiety levels of patients who received and did not receive preoperative training; studies have revealed that patients who underwent preoperative training had lower levels of anxiety than those who did not. The patients in the intervention group cooperated more with health specialists and followed the procedures of the professionals [7, 49].

According to the studies, most of the solutions used to educate patients were based on video resources (as shown in Fig. 4). Educational videos do not require an actor or camera equipment, and it is relatively easy to add, remove or modify content in animated videos. The flexibility of videos to adapt clinical practices is a crucial variable [50]. Based on the studies reviewed in this study, video-based education can certainly support patient learning. However, more cumulative research is required to make evidence-based advances in the principles of video-based training in hospitals setting [51]. Based on the reviewed studies, virtual reality-based systems or environments have been used to educate patients. This technology causes patients to be immersed in the built environment, and facilities the learning of educational content in the best possible way [52]. Adopting a patient education system through the use of interactive technologies such as virtual and augmented reality in any organization is a significant and positive change that leads to improved quality of treatment and care [53].

There are strengths and limitations to this study. Strengths included using a search strategy with mesh terms that led to the identification of valuable studies. Also, the three authors extracted the data and screened the selected papers. This study also has two limitations. The first limitation is that non-English studies were excluded. Second limitation is that, the articles were retrieved based on a search of three databases, so some related studies may have been lost.

Implications for practice

Educational approaches or technologies used to educate patients with various heart surgeries have replaced traditional approaches and teaching methods in recent years. However, due to the growing global need to use computer-based tools, this issue extends rapidly in modern countries. Therefore, it is suggested that developing countries should also provide a suitable platform for these studies. On the other hand, the cost of technology and innovative materials, as well as time, place and implementation methods vary greatly depending on the details of the application, but most of them are expensive and require enough space such as virtual environments or video resources. Furthermore, it is recommended that governments should plan for this type of training and related expenditures to improve patients’ knowledge or quality of life.

Conclusion

In this systematic review, 29 articles related to the application of educational approaches and their effect on patients after heart surgery were analyzed. Almost all educational approaches and technologies have the functionality of reducing patient stress or anxiety and enhancing their satisfaction. Educational approaches have good potential to improve the quality of life and knowledge of patients. Therefore, technology and educational contents can be used as approaches to treatment management and care that aim to help control therapeutic interventions. Also, health policymakers are currently considering these technologies, because using them will reduce the financial burden on healthcare organizations.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

References

  1. Balkhy HH, Amabile A, Torregrossa G. A shifting paradigm in robotic heart surgery: from single-procedure approach to establishing a robotic heart center of excellence. Los Angeles, CA: SAGE Publications Sage CA; 2020.

    Google Scholar 

  2. Cohen RG, Kumar SR, Lin J, Reddy RM, Kane L, Bagley J, et al. The disparity between public utilization and surgeon awareness of the STS patient education website. Ann Thorac Surg. 2020;110(1):284–9.

    Article  PubMed  Google Scholar 

  3. Shah SJ, Borlaug BA, Kitzman DW, McCulloch AD, Blaxall BC, Agarwal R, et al. Research priorities for heart failure with preserved ejection fraction: national heart, lung, and blood institute working group summary. Circulation. 2020;141(12):1001–26.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Spadaccio C, Glineur D, Barbato E, Di Franco A, Oldroyd KG, Biondi-Zoccai G, et al. Fractional flow reserve–based coronary artery bypass surgery: current evidence and future directions. Cardiovasc Inter. 2020;13(9):1086–96.

    Google Scholar 

  5. Salehmoghaddam A, Zoka A, Mazlom S, Amni S. Effect of instructional videos on postoperative respiratory function in patients undergoing off-pump open heart surgery. Evid Based Care. 2016;6(2):57–66.

    Google Scholar 

  6. Nellipudi JA, Baker RA, Dykes L, Krieg BM, Bennetts JS. Prognostic Value of high-sensitivity troponin t after on-pump coronary artery bypass graft surgery. Heart Lung Circ. 2021;30(10):1562–9.

    Article  PubMed  Google Scholar 

  7. Liu J-J, Chou F-H, Yeh S-H. Basic needs and their predictors for intubated patients in surgical intensive care units. Heart Lung. 2009;38(3):208–16.

    Article  PubMed  Google Scholar 

  8. Hoseini S, Soltani F, Babaee Beygi M, Zarifsanaee N. The effect of educational audiotape programme on anxiety and depression in patients undergoing coronary artery bypass graft. J Clin Nurs. 2013;22(11–12):1613–9.

    Article  PubMed  Google Scholar 

  9. Khorfan R, Shallcross ML, Yu B, Sanchez N, Parilla S, Coughlin JM, et al. Preoperative patient education and patient preparedness are associated with less postoperative use of opioids. Surgery. 2020;167(5):852–8.

    Article  PubMed  Google Scholar 

  10. Tavangar H, Madadizadeh F, Kalani Z, Beygi Rizi R, Tavakoli Z, Shokati Ahmad Abad M. Evaluation of the individual education effect on anxiety in elderly candidates for open-heart surgery. Int J Epidemiol Health Sci. 2021;2(8):1.

    Google Scholar 

  11. Fouad MR, Ali ZH, Abd Hafez NGE. Evidence of pre and post-operative care for open heart surgery patient’s on physiological and psychological outcomes. 7(1):1185–1201.

  12. Bjørnnes AK, Parry M, Lie I, Fagerland MW, Watt-Watson J, Rustøen T, et al. The impact of an educational pain management booklet intervention on postoperative pain control after cardiac surgery. Eur J Cardiovasc Nurs. 2017;16(1):18–27.

    Article  PubMed  Google Scholar 

  13. Shoushi F, Janati Y, Mousavinasab N, Kamali M, Shafipour V. The impact of family support program on depression, anxiety, stress, and satisfaction in the family members of open-heart surgery patients. J Nurs Midwifery Sci. 2020;7(2):69.

    Article  Google Scholar 

  14. Skiff A, Goodwin NJ, Goldstein MF. A practical approach to assessing patient learning needs. J Natl Med Assoc. 1981;73(6):533.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Widmer RJ, Allison TG, Lennon R, Lopez-Jimenez F, Lerman LO, Lerman A. Digital health intervention during cardiac rehabilitation: a randomized controlled trial. Am Heart J. 2017;188:65–72.

    Article  PubMed  Google Scholar 

  16. Yu R-X, Müller-Riemenschneider F. Effectiveness of exercise after PCI in the secondary prevention of coronary heart disease: A systematic review. Europ J Integrative Med. 2011;3(2):e63–9.

    Article  Google Scholar 

  17. Furuya RK, Arantes EC, Dessotte CA, Ciol MA, Hoffman JM, Schmidt A, et al. A randomized controlled trial of an educational programme to improve self-care in Brazilian patients following percutaneous coronary intervention. J Adv Nurs. 2015;71(4):895–908.

    Article  PubMed  Google Scholar 

  18. Guo P, East L, Arthur A. A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial. Int J Nurs Stud. 2012;49(2):129–37.

    Article  PubMed  Google Scholar 

  19. Kamarajah SK, Bundred J, Weblin J, Tan BH. Critical appraisal on the impact of preoperative rehabilitation and outcomes after major abdominal and cardiothoracic surgery: a systematic review and meta-analysis. Surgery. 2020;167(3):540–9.

    Article  PubMed  Google Scholar 

  20. Rethlefsen ML, Kirtley S, Waffenschmidt S, Ayala AP, Moher D, Page MJ, et al. PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev. 2021;10(1):1–19.

    Article  Google Scholar 

  21. Ramesh C, Nayak BS, Ravishankar N, George LS, Devi ES, George A. Effects of foot massage and patient education in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial. Complement Ther Clin Pract. 2020;40:1–9.

    Google Scholar 

  22. Cook DJ, Moradkhani A, Douglas KSV, Prinsen SK, Fischer EN, Schroeder DR. Patient education self-management during surgical recovery: combining mobile (iPad) and a content management system. Telemedicine and e-Health. 2014;20(4):312–7.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Oliveira APAd, Souza ENd, Pellanda LC. Effectiveness of video resources in nursing orientation before cardiac heart surgery. Rev Assoc Med Bras. 2016;62:762–7.

    Article  PubMed  Google Scholar 

  24. Fredericks S, Yau T. Relationship between post-operative patient education. Int J Health Promot Educ. 2013;51(4):228–34.

    Article  Google Scholar 

  25. Kadda O, Manginas A, Stavridis G, Balanos D, Kotiou M, Panagiotakos DB. Gender analysis in the outcomes of a lifestyle intervention among patients who had an open heart surgery. Angiology. 2016;67(1):66–74.

    Article  CAS  PubMed  Google Scholar 

  26. Lai VKW, Ho KM, Wong WT, Leung P, Gomersall CD, Underwood MJ, et al. Effect of preoperative education and ICU tour on patient and family satisfaction and anxiety in the intensive care unit after elective cardiac surgery: a randomised controlled trial. BMJ Qual Saf. 2021;30(3):228–35.

    Article  PubMed  Google Scholar 

  27. Lai VKW, Lee A, Leung P, Chiu CH, Ho KM, Gomersall CD, et al. Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention. BMJ Open. 2016;6(6): e011341.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lowres N, Mulcahy G, Gallagher R, Ben Freedman S, Marshman D, Kirkness A, et al. Self-monitoring for atrial fibrillation recurrence in the discharge period post-cardiac surgery using an iPhone electrocardiogram. Eur J Cardiothorac Surg. 2016;50(1):44–51.

    Article  PubMed  Google Scholar 

  29. Martorella G, Cote J, Choiniere M (2013) Soulage-Tavie: development and validation of a virtual nursing intervention to promote self-management of postoperative pain after cardiac surgery. CIN: Comput Inform Nurs 31(4): 189–97.

  30. McGillion M, Ouellette C, Good A, Bird M, Henry S, Clyne W, et al. Postoperative remote automated monitoring and virtual hospital-to-home care system following cardiac and major vascular surgery: user testing study. J Med Internet Res. 2020;22(3): e15548.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Melholt C, Joensson K, Spindler H, Hansen J, Andreasen JJ, Nielsen G, et al. Cardiac patients’ experiences with a telerehabilitation web portal: Implications for eHealth literacy. Patient Educ Couns. 2018;101(5):854–61.

    Article  PubMed  Google Scholar 

  32. Moghimian M, Akbari M, Moghaddasi J, Niknajad R. Effect of digital storytelling on anxiety in patients who are candidates for open-heart surgery. J Cardiovasc Nurs. 2019;34(3):231–5.

    Article  PubMed  Google Scholar 

  33. O’Brien L, McKeough C, Abbasi R. Pre-surgery education for elective cardiac surgery patients: A survey from the patient’s perspective. Aust Occup Ther J. 2013;60(6):404–9.

    Article  PubMed  Google Scholar 

  34. Pazar B, Iyigun E. The effects of preoperative education of cardiac patients on haemodynamic parameters, comfort, anxiety and patient-ventilator synchrony: A randomised, controlled trial. Intensive Crit Care Nurs. 2020;58: 102799.

    Article  PubMed  Google Scholar 

  35. Wakefield B, Drwal K, Scherubel M, Klobucar T, Johnson S, Kaboli P. Feasibility and effectiveness of remote, telephone-based delivery of cardiac rehabilitation. Telemedicine and e-Health. 2014;20(1):32–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Pakrad F, Ahmadi F, Grace SL, Oshvandi K, Kazemnejad A. Traditional vs extended hybrid cardiac rehabilitation based on the continuous care model for patients who have undergone coronary artery bypass surgery in a middle-income country: A randomized controlled trial. Archiv Phys Med Rehabil. 2021;102(11):2091–101.

    Article  Google Scholar 

  37. Mayer-Berger W, Simic D, Mahmoodzad J, Burtscher R, Kohlmeyer M, Schwitalla B, et al. Efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on risk and health-related quality of life in a low-education cohort: a randomized controlled study. Eur J Prev Cardiol. 2014;21(2):145–52.

    Article  PubMed  Google Scholar 

  38. Kalogianni A, Almpani P, Vastardis L, Baltopoulos G, Charitos C, Brokalaki H. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery? Eur J Cardiovasc Nurs. 2016;15(6):447–58.

    Article  PubMed  Google Scholar 

  39. Wang L-W, Ou S-H, Tsai C-S, Chang Y-C, Kao C-W. Multimedia exercise training program improves distance walked, heart rate recovery, and self-efficacy in cardiac surgery patients. J Cardiovasc Nurs. 2016;31(4):343–9.

    Article  PubMed  Google Scholar 

  40. Bikmoradi A, Masmouei B, Ghomeisi M, Roshanaei G, Masiello I. Impact of telephone counseling on the quality of life of patients discharged after coronary artery bypass grafts. Patient Educ Couns. 2017;100(12):2290–6.

    Article  PubMed  Google Scholar 

  41. Coskun H, Senture C, Ustunsoz A. The effectiveness of discharge training for patients after cardiac surgery. Rehabil Nurs 2016.

  42. Fahimi K, Abbasi A, Zahedi M, Amanpour F, Ebrahimi H. The effects of multimedia education on postoperative delirium in patients undergoing coronary artery bypass graft: A randomized clinical trial. Nurs Crit Care. 2020;25(6):346–52.

    Article  PubMed  Google Scholar 

  43. Fredericks S, Yau T. Educational intervention reduces complications and rehospitalizations after heart surgery. West J Nurs Res. 2013;35(10):1251–65.

    Article  PubMed  Google Scholar 

  44. Varnfield M, Karunanithi M, Lee C-K, Honeyman E, Arnold D, Ding H, et al. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial. Heart. 2014;100(22):1770–9.

    Article  PubMed  Google Scholar 

  45. Blumenthal JA, Sherwood A, Babyak MA, Watkins LL, Waugh R, Georgiades A, et al. Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease: a randomized controlled trial. JAMA. 2005;293(13):1626–34.

    Article  CAS  PubMed  Google Scholar 

  46. Khanal S, Elsey H, King R, Baral SC, Bhatta BR, Newell JN. Development of a patient-centred, psychosocial support intervention for multi-drug-resistant tuberculosis (MDR-TB) care in Nepal. PLoS ONE. 2017;12(1): e0167559.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Giordano A, Bonometti GP, Vanoglio F, Paneroni M, Bernocchi P, Comini L, et al. Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial. BMC Geriatr. 2016;16(1):209.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Khoram B, Yoosefinejad AK, Rivaz M, Najafi SS. Investigating the Effect of Acupressure on the Patients’ Anxiety Before Open-Heart Surgery: A Randomized Clinical Trial. J Acupunct Meridian Stud. 2020;13(6):169–73.

    Article  PubMed  Google Scholar 

  49. Kim H, Garvin BJ, Moser DK. Stress during mechanical ventilation: benefit of having concrete objective information before cardiac surgery. Am J Crit Care. 1999;8(2):118.

    Article  CAS  PubMed  Google Scholar 

  50. Cruz-Oliver DM, Rueda AP, Viera-Ortiz L, Washington KT, Oliver DP. The evidence supporting educational videos for patients and caregivers receiving hospice and palliative care: a systematic review. Patient Educ Counsel. 2020;103(9):1677–91.

    Article  Google Scholar 

  51. Schmitz FM, Schnabel KP, Stricker D, Fischer MR, Guttormsen S. Learning communication from erroneous video-based examples: A double-blind randomised controlled trial. Patient Educ Couns. 2017;100(6):1203–12.

    Article  PubMed  Google Scholar 

  52. Lok B, Ferdig RE, Raij A, Johnsen K, Dickerson R, Coutts J, et al. Applying virtual reality in medical communication education: current findings and potential teaching and learning benefits of immersive virtual patients. Virtual Reality. 2006;10(3–4):185–95.

    Article  Google Scholar 

  53. Baniasadi T, Ayyoubzadeh SM, Mohammadzadeh N. Challenges and practical considerations in applying virtual reality in medical education and treatment. Oman Med J. 2020;35(3): e125.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This research was supported by Tehran University of Medical Sciences & Health Services (TUMS), (Ethics approval number: IR.TUMS.SPH.REC.1398.117).

Funding

In this paper, we do not receive any financial fund.

Author information

Authors and Affiliations

  1. Health Information Management Department and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran

    Leila Shahmoradi & Sorayya Rezayi

  2. Medical Library and Information Science, Tehran University of Medical Sciences, Tehran, Iran

    Nafiseh Rezaei

  3. Department of Medical Library and Information Science, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran

    Nafiseh Rezaei

  4. Department of eLearning in Medical Education, Virtual School of Tehran University of Medical Sciences, Naderi Street, Keshavarz Blvd, Tehran, Iran

    Mitra Zolfaghari

  5. Department of Heart Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

    Babak Manafi

Authors
  1. Leila Shahmoradi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nafiseh Rezaei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sorayya Rezayi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mitra Zolfaghari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Babak Manafi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Authors LS/NR/SR wrote the first draft of the manuscript. Authors LS/NR/SR performed data collection and analysis, and also extracted the main characteristics. All authors (SR/LS/NR/MZ/BM) reviewed the manuscript and provided critical feedback. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Nafiseh Rezaei or Sorayya Rezayi.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that there is no conflict of interest regarding the publication of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shahmoradi, L., Rezaei, N., Rezayi, S. et al. Educational approaches for patients with heart surgery: a systematic review of main features and effects. BMC Cardiovasc Disord 22, 292 (2022). https://doi.org/10.1186/s12872-022-02728-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12872-022-02728-0

Keywords

BMC Cardiovascular Disorders

ISSN: 1471-2261

Contact us