Interactive Voice Response Technology and Surgical Monitoring for Cardiac Patients in Pre-Habilitation and Post-Surgery: Evidence of Impacts on Process and Outcomes of Care

Abstract

Abstract Background: In cardiac surgery, poorer health-related quality of life (HRQOL) after surgery has been associated with worse survival outcomes. However, it is unclear how HRQOL is impacted by a combination of a cardiac surgical procedure and a patient health optimizing process prior to surgery known as “prehabilitation”. This study addresses this area by investigating changes in HRQOL among cardiac surgery patients undergoing prehabilitation. Methods: Prehabilitation program patients (n=460) awaiting coronary artery bypass graft (CABG) surgery over a 31-month period were included in the study. All patients completed the 12-item short-form (SF-12; physical component scale, PCS-12; and mental component scale, MCS-12) health survey HRQOL questionnaire at 1-day post-program enrolment (pre-surgery) and at 3-months post-CABG surgery discharge via automated interactive voice response (IVR) system call. Patients were stratified by whether they raised a flag in the pre-surgery IVR call, indicating need for prehabilitation intervention. Results: Before surgery, non-flagged patients (i.e., no intervention needed pre-surgery) (n=129) had a statistically significant higher median MCS-12 score than flagged patients (n=331); PCS-12 score difference pre-surgery was statistically insignificant. After discharge, median MCS-12 and PCS-12 scores increased for both groups. but only the PCS-12 score difference was statistically significant. However, no significant differences in ranked change scores for MCS-12 and PCS-12 were noted, indicating comparable effects post-surgery. Conclusion: HRQOL for patients needing prehabilitation intervention improved and was comparable to non-flagged patients’ HRQOL post-discharge. Since flagged patients had lower mental HRQOL than non-flagged patients’ pre-surgery, IVR-enabled prehabilitation improved mental wellbeing by providing a feeling of security and involvement in their health.