Differences in coronary artery disease complexity and associations with mortality and hospital admissions among First Nations and non-First Nations patients undergoing angiography: a comparative retrospective matched cohort study.

BACKGROUND: First Nations people are more likely than the general population to experience long-term adverse health outcomes after coronary angiography. Our aim was to quantify the extent of coronary artery disease among First Nations and non-First Nations patients undergoing angiography to investigate differences in coronary artery disease and related health disparities. METHODS: We conducted a retrospective matched cohort study to compare health outcomes of First Nations and non-First Nations adult patients (> 18 yr) who underwent index angiography between Apr. 1, 2008, and Mar. 31, 2012, in Manitoba, Canada. The SYNTAX Score was used to measure and compare severity of coronary artery disease between groups. Primary outcomes of all-cause and cardiovascular mortality were compared between groups using Cox proportional hazard models adjusted by SYNTAX Score results and weighted by the inverse probability of being First Nations. Secondary outcomes included all-cause and cardiovascular-related hospital admissions. RESULTS: The cohort consisted of 277 matched pairs of First Nations and non-First Nations patients undergoing angiography; the average age of patients was 56.0 (standard deviation 11.7) years. The median SYNTAX Score results and patient distributions across categories in the matched paired cohort groups were not significantly different. Although proportionally First Nations patients showed worse health outcomes, mortality risks were similar in the weighted sample, even after controlling for revascularization and SYNTAX Score results. Secondary outcomes showed that adjusted risks for hospital admission for acute myocardial infarction (adjusted hazard ratio [HR] 3.03, 95% confidence interval [CI] 1.40-6.55) and for congestive heart failure (adjusted HR 3.84, 95% CI 1.37-10.78) were significantly higher among First Nations patients in the weighted sample. INTERPRETATION: The extent of coronary artery disease among matched cohort groups of First Nations and non-First Nations patients appears similar, and controlling for baseline sociodemographic characteristics, coronary artery disease risk factors and SYNTAX Score results explained higher mortality risk and most hospital admissions among First Nations patients. Although there is a need to decrease risk factors for coronary artery disease among First Nations populations, addressing individuals' behaviour without considering root causes underlying risk factors for coronary artery disease will fail to decrease health outcome disparities among First Nations patients undergoing angiography.

Clinical placement anxiety in undergraduate nursing students: A concept analysis.

OBJECTIVE: The primary aim of this review was to complete an in-depth analysis of clinical placement anxiety in undergraduate nursing students. Our overall goal was to establish a strong foundation for clinical education strategies and future research on clinical placement anxiety in nursing education. DESIGN & METHODS: We utilized Walker and Avant's systematic 8-step approach to concept analysis as a framework to develop a comprehensive understanding of clinical placement anxiety in undergraduate students. DATA SOURCES: A review of existing literature on clinical placement anxiety was conducted using the electronic databases of PubMed, CINAHL, and PsychInfo, as well as a grey literature and snowball search. Search terms included clinical placement, clinical experience, nursing students, undergraduate nursing students, and anxiety. RESULTS: The literature search resulted in 81 articles that met the inclusion criteria. Five defining attributes were identified: a vague or unknown threat, psychological-emotional responses, psychological-cognitive responses, physiological responses, and unfamiliar environments or situations. Antecedents, consequences, and empirical referents of the concept were also highlighted. CONCLUSIONS: Insights gleaned from this concept analysis may enhance the ability of clinical nursing educators to effectively prevent and manage student anxiety in the clinical setting. By contextualizing anxiety, we have also validated the importance of further exploration of the anxiety experienced by undergraduate nursing students during their clinical experiences. Thus, this concept analysis establishes the foundation for educational strategies, as well as future research in nursing education.

Exploring Stroke Outcomes Following a Door-to-Needle Quality Improvement Project.

BACKGROUND: Although stroke rates in Canada are expected to increase dramatically over the next decade, time-driven hyperacute stroke care with thrombolysis increases the likelihood of a good clinical outcome. Following a period of suboptimal performance results for stroke care, our tertiary care center undertook a door-to-needle (DTN) quality improvement initiative. The purpose of our study was to determine if the resulting improved median DTN times and greater proportion of patients treated within 60 minutes of arrival at our emergency department were associated with improved clinical outcomes. METHODS: Guided by the Donabedian quality framework, we retrospectively reviewed charts of consecutive patients (n = 324) who received thrombolysis pre- and post-quality improvement initiative. Data on patient characteristics, and process and outcome measures were collected. Primary study outcomes included mortality, adverse events, discharge location, and independence at discharge. Data analysis compared proportions with Chi Square and means using the two-tailed t-test and a 0.05 level of significance. RESULTS: Median DTN times and the percentage of cases with a DTN ≤60 minutes improved significantly post-intervention (p < 0.001). In-hospital mortality decreased (p = 0.013), and the proportion of favorable versus unfavorable discharge locations improved (p = 0.005). Mortality rates for all study patients with DTN ≤60 versus >60 minutes were also significantly lower (p = 0.044) post-intervention. CONCLUSIONS: Our quality improvement initiative resulted in timelier care and positively influenced clinical outcomes. This study highlights the need for ongoing, innovative investment strategies to ensure timely hyperacute stroke care and optimal patient outcomes.

Cardiovascular Medication Use and Long-Term Outcomes of First Nations and Non-First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort Study.

Background In Canada, First Nations (FN) people are at greater risk of mortality than the general population following index angiography. This disparity has not been investigated while considering guideline-recommended cardiovascular medication use. Methods and Results Retrospective analysis of administrative health data investigated patterns of medication dispensation during the first year after index angiography among patients in Manitoba, Canada. Medication possession ratios (MPRs) reflecting the percentage of days in which medications were supplied were calculated separately for ß-blockers, angiotensin-converting enzyme inhibitors, statins, and antiplatelets (clopidogrel). Patients were assigned to 1 of 4 categories: (1) not dispensed (0% MPR), (2) low (1-39% MPR), (3) intermediate (40-79% MPR), (4) high (≥80% MPR). Cox regression models that adjusted for MPR categories were used to explore the association between FN patients and both 5-year all-cause mortality and cardiovascular mortality. FN patients were less likely to have an intermediate MPR (odds ratio: 0.75; 95% CI, 0.57-0.99) or a high MPR (odds ratio: 0.64; 95% CI, 0.50-0.81) for statin medications than non-FN patients. FN patients also had higher adjusted risks of all-cause and cardiovascular mortality than non-FN patients (hazard ratio, all-cause: 1.54 [95% CI, 1.25-1.89]; cardiovascular: 1.62 [95% CI, 1.16-2.25]). Conclusions FN status was independently associated with intermediate and high MPRs for statins during the first year following index angiography among patients with known ischemic heart disease. Differences in MPR categories did not explain the disparity in all-cause and cardiovascular mortality between the 2 populations. Reduction of cardiovascular disparities may be best addressed using primary prevention strategies that include decolonizing policies and practices.

Health Outcome and Follow-up Care Differences Between First Nation and Non-First Nation Coronary Angiogram Patients: A Retrospective Cohort Study.

BACKGROUND: First Nations (FN) people experience high rates of ischemic heart disease (IHD) morbidity and mortality. Increasing access to angiography may lead to improved outcomes. We compared various outcomes and follow-up care post-index angiography between FN and non-FN patients. METHODS: All index angiography patients in Manitoba were identified between April 1, 2000 and March 31, 2009 and categorized into acute myocardial infarction (AMI) or non-AMI groups based on whether their angiogram occurred within 7 days of an AMI. Cox proportional hazard models estimated associations between FN status and outcomes related to mortality, subsequent hospitalizations, revascularizations, and physician visits. RESULTS: Cardiovascular mortality was higher among FN patients in the non-AMI group (hazard ratio [HR] = 1.50, 95% confidence interval [CI], 1.17-1.94) and in the AMI group (HR = 1.57, 95% CI, 1.05-2.35). FN patients were also more likely to have a subsequent hospitalization for AMI (HR = 2.26, 95% CI, 1.79-2.85) in the non-AMI group. FN patients in the non-AMI group were less likely to receive percutaneous coronary intervention (HR = 0.85, 95% CI, 0.73-0.99) and more likely to undergo coronary artery bypass graft (HR = 1.26, 95% CI, 1.10-1.45). FN patients in both groups were less likely to visit a cardiologist/cardiac surgeon, internal medicine specialist, or family physician within 3 months and 1 year of angiography. CONCLUSIONS: Cardiovascular health and follow-up care outcomes of FN and non-FN patients who undergo angiography are not the same. Addressing Indigenous determinants of health are necessary to improve cardiovascular outcomes.

Index coronary angiography use in Manitoba, Canada: a population-level descriptive analysis of First Nations and non-First Nations recipients.

OBJECTIVES: To investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada. SETTING: Population-based, secondary analysis of provincial administrative health data. PARTICIPANTS: All adults 18 years or older who received an index angiogram between 2000/2001 and 2008/2009. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Descriptive statistics for age, sex, income quintile by rural and urban residency and Charlson Comorbidity Index for FN and non-FN recipients. (2) Annual index angiogram rates for FN and non-FN populations and among those rates of 'urgent' angiograms based on acute myocardial infarction (AMI)-related hospitalisations during the previous 7 days. (3) Proportions of people who did not receive an angiogram in the 20 years preceding an ischaemic heart disease (IHD) diagnosis or a cardiovascular death; stratified by age (<65 or ≥65 years old). RESULTS: FN recipients were younger (56.3vs63.8 years; p<0.0001) and had higher Charlson Comorbidity scores (1.32vs0.78; p<0.001). During all years examined, index angiography rates were lower among FN people (2.67vs3.33 per 1000 population per year; p<0.001) with no notable temporal trends. Among the index angiogram recipients, a higher proportion was associated with an AMI-related hospitalisation in the FN group (28.8%vs25.0%; p<0.01) and in both groups rates significantly increased over time. FN people who died from cardiovascular disease or were older (65+years old) diagnosed with IHD were more likely to have received an angiogram in the preceding 20-30 years (17.8%vs12.5%; p<0.01 and 50.9%vs49.5%; p<0.03, respectively). FN people diagnosed with IHD who were under the age of 65 were less likely to have received an angiogram (47.8%vs53.1%; p<0.01) CONCLUSIONS: Index angiogram use differences are suggested between FN and non-FN populations, which may contribute to reported IHD disparities. Investigating factors driving these rates will determine any association between ethnicity and angiography services.

Test Anxiety in the Nursing Skills Laboratory: A Concept Analysis.

BACKGROUND: The concept of test anxiety has been well documented within the health education literature, with much of the literature addressing the clinical environment and simulation laboratories. Minimal exploration of test anxiety has been conducted within the context of a nursing skills laboratory. AIM: This concept analysis of test anxiety will provide clarity to the meaning and use of this concept within the nursing educational setting of a controlled skills laboratory. METHOD: Walker and Avant's (2005) framework was used to identify the defining attributes, antecedents, and consequences of test anxiety and applied in model, borderline, and contrary cases, and empirical referents. CONCLUSIONS: Understanding the concept of test anxiety will enable nurse educators to develop strategies to reduce student anxiety during testing in the skill laboratory. These insights can lead to positive changes within the nursing curricula and may benefit those students who experience testing anxiety.

Reframing tobacco dependency management in acute care: A case study.

Effective tobacco dependence treatment within acute care tends to be inadequate. The purpose of the Utilizing best practices to Manage Acute care patients Tobacco Dependency (UMAT) was to implement and evaluate an evidence-based intervention to support healthcare staff to effectively manage nicotine withdrawal symptoms of acute surgical patients. Data collection for this one-year longitudinal case study included: relevant patient experiences and staff reported practice, medication usage, and chart review. Over the year each data source suggested changes in tobacco dependence treatment. Key changes in patient survey responses (N=55) included a decrease in daily smoking and cigarette cravings. Of patients who used nicotine replacement therapy, they reported an increase in symptom relief. Staff (N=45) were surveyed at baseline, mid-point and end of study. Reported rates of assessing smoking status did not change over the year, but assessment of withdrawal symptoms emerged as daily practice and questions about cessation diminished. Also delivery of nicotine replacement therapy products increased over the year. Chart reviews showed a shift in content from documenting smoking behavior to withdrawal symptoms and administration of nicotine replacements; also frequency of comments increased. In summary, the evidence-based intervention influenced unit norms and reframed the culture related to tobacco dependence treatment.

Exploring the Perceptions and Health Behaviours of Patients Following an Elective Ad-hoc Percutaneous Coronary Intervention: A Qualitative Study.

RESULTS: Participants expressed uncertainty about their future health and feared disease recurrence, which appeared to provide motivation for adopting a healthier lifestyle. Although two participants voiced the belief that the elective PCI cured their disease, this perception did not appear to influence their engagement in risk reduction behaviours. However, systemfactors such as a lack of information, direction, and/or support from health care providers appeared to play a limiting role in their ability to move forward with lifestyle change. BACKGROUND: Elective ad-hoc percutaneous coronary interventions (PCIs) are increasingly used to manage the symptoms of coronary artery disease (CAD). However, we have limited understanding of the patients' experiences and health behaviours post-procedure. PURPOSE: Explore the factors that influence the perceptions and health behaviours of patients after elective ad-hoc PCI. METHODS: This interpretive descriptive study used purposive sampling to recruit participants (N = 10) aged 44 to 65 years following an elective ad-hoc PCI from a cardiac catheterization laboratory at a tertiary centre in Winnipeg, MB. Participants were interviewed 11 to 35 days following their procedure. Recruitment continued until no new substantive themes emerged. The Health Belief Model provided the frameworkfor developing, exploring, interpreting, and analyzing the data. PRACTICE IMPLICATIONS: Nurses have a key role in the education of patients and in providingpatient-centred care that supports lifestyle change. Nurses need to develop strategies that decrease barriers to engaging in risk reduction behaviours following elective ad-hoc PCI if patients are to experience improved health and longevity.

Emergency Nurses' Perspectives: Factors Affecting Caring.

UNLABELLED: Caring is a universal phenomenon. However, as a result of higher patient acuity and staff shortages within the chaotic ED environment, caring behaviors may be in peril. The purpose of this study was to gain insight into the meaning of caring from the perspective of emergency nurses. Exploring nurses' perspectives of caring is central to improving staffing and retention issues in this unique work environment. METHODS: As part of a larger study, a subsample of emergency nurses who work in public hospitals in Manitoba, Canada (n = 17) were interviewed. A qualitative descriptive design was used to gain insight into the caring perspectives of nurses by asking them, "What does caring meaning to you?" and "What affects caring in your practice in the emergency department?" Emerging themes were extracted through analysis of audio tapes and transcripts. RESULTS: Advocacy and holistic care emerged as major themes in the meaning of caring for emergency nurses. Caring was affected by a number of factors, including workload, lack of time, staffing issues, shift work, and lack of self-care. However, lack of management support was the most consistent hindrance to caring identified by study participants. DISCUSSION: Caring continues to be a unifying concept in nursing; however, influencing factors continue to undermine caring for emergency nurses. Caring is not subsidiary to nursing; it is the central core of nursing. Therefore, fostering a caring working environment is essential for nurses to practice holistic nursing care. It is also imperative to job satisfaction and the retention of emergency nurses.

"Time is Brain:" A concept anaiysis.

Time is brain has been heard echoing in the world of acute stroke since the early nineties. At that time, the use of intravenous recombinant tissue plasminogen activator (rt-PA) revolutionized the approach to treating acute ischemic stroke. However, the use of rt-PA is strongly time dependant, with a narrow window of opportunity of only 4.5 hours. There is also convincing scientific evidence of a significant relationship between time to rt-PA treatment and patient outcomes. Similar to rt-PA in the '90s, time sensitive endovascular therapy has transformed the treatment of acute stroke. Hence, time is brain has been referred to as a battle cry, with these three words significantly influencing the multidisciplinary stroke teams who provide care to stroke victims. Despite agreement in the scientific literature that time is brain represents the essence of hyperacute stroke care, this concept has not been studied through the methodological approach of a concept analysisframework. Therefore, the purpose of this concept analysis was to explore the concept of time is brain within the context of acute stroke. Walker and Avants (2011) approach to concept analyses was used to gain insight into the provision of optimal acute stroke care in clinical nursing practice.

Identifying the key predictors for retention in critical care nurses.

AIMS: The aim of this study was to explore the key predictors of retention in nurses working in critical care areas. BACKGROUND: The shortage of critical care nurses is reaching crisis proportions in Canada and throughout the industrialized world. Identifying the key influencing (i.e. person and organizational) factors and intermediary factors (i.e. job satisfaction, engagement, professional quality of life and caring) that affect intent to leave is central to developing optimal retention strategies for critical care nurses. DESIGN: As part of a larger mixed-methods study, we used a quantitative, cross-sectional research design. A novel framework: the Conceptual Framework for Predicting Nurse Retention was used to guide this study. METHODS: On-line survey data were collected from on a convenience sample of 188 registered nurses working in critical care areas of hospitals in the province of Manitoba, CANADA in 2011. RESULTS: Twenty-four per cent of the respondents reported that they would probably/definitely leave critical care in the next year. Based on bivariate and regression analyses, the key influencing factors that were significantly related to the intermediary factors and intent to leave critical care and nursing included: professional practice, management, physician/nurse collaboration, nurse competence, control/responsibility and autonomy. Of the intermediary factors, all but compassion satisfaction were related to intent to leave both critical care and nursing. CONCLUSION: This study highlights the importance of exploring multiple organizational and intermediary factors to determine strategies to retain critical care nurses. The findings also support the Conceptual Framework for Predicting Nurse Retention as a theoretical basis for further research.

Protocol for the PREHAB study-Pre-operative Rehabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery: a randomised controlled trial.

INTRODUCTION: Frailty is a geriatric syndrome characterised by reductions in muscle mass, strength, endurance and activity level. The frailty syndrome, prevalent in 25-50% of patients undergoing cardiac surgery, is associated with increased rates of mortality and major morbidity as well as function decline postoperatively. This trial will compare a preoperative, interdisciplinary exercise and health promotion intervention to current standard of care (StanC) for elective coronary artery bypass and valvular surgery patients for the purpose of determining if the intervention improves 3-month and 12-month clinical outcomes among a population of frail patients waiting for elective cardiac surgery. METHODS AND ANALYSIS: This is a multicentre, randomised, open end point, controlled trial using assessor blinding and intent-to-treat analysis. Two-hundred and forty-four elective cardiac surgical patients will be recruited and randomised to receive either StanC or StanC plus an 8-week exercise and education intervention at a certified medical fitness facility. Patients will attend two weekly sessions and aerobic exercise will be prescribed at 40-60% of heart rate reserve. Data collection will occur at baseline, 1-2 weeks preoperatively, and at 3 and 12 months postoperatively. The primary outcome of the trial will be the proportion of patients requiring a hospital length of stay greater than 7 days. POTENTIAL IMPACT OF STUDY: The healthcare team is faced with an increasingly complex older adult patient population. As such, this trial aims to provide novel evidence supporting a health intervention to ensure that frail, older adult patients thrive after undergoing cardiac surgery. ETHICS AND DISSEMINATION: Trial results will be published in peer-reviewed journals, and presented at national and international scientific meetings. The University of Manitoba Health Research Ethics Board has approved the study protocol V.1.3, dated 11 August 2014 (H2014:208). TRIAL REGISTRATION NUMBER: The trial has been registered on ClinicalTrials.gov, a registry and results database of privately and publicly funded clinical studies (NCT02219815).

Exploring professional development needs of educators in the health sciences professions.

An increasing number of institutions of higher education are clustering their health sciences schools into a common unit. Therefore, it is imperative that the individual faculty development units assume new mandates to meet faculty development needs for stakeholders across these disciplines. Critical to providing current and relevant professional development activities is an awareness of the needs of academicians, including common as well as discipline-specific needs. Hence, the aim of this study was to explore the extent to which factors such as discipline, rank, gender, education, and years as an academician impact on perceived needs for faculty development. In February 2012, a cross-sectional survey of the perceived faculty development needs of academicians in the health sciences unit of a Canadian university was conducted using an online assessment tool. A total of 133 out of 1,409 potential participants completed the survey, for a response rate of 9.4%. The findings revealed more similarities than differences in terms of perceived faculty development needs. In addition, differences were found across all health professions schools and in factors such as discipline, academic rank, education, gender, and years as an academician. These findings suggest that faculty development and educational specialists should understand the shared as well as the unique needs of the individual health sciences schools in planning their professional development services.

Post-operative nausea and vomiting in the cardiac surgery population: who is at risk?

OBJECTIVES: Post-operative nausea and vomiting (PONV) is a common and distressing complication following cardiac surgery. Therefore, our primary objective was to explore the predictors of severe PONV in the cardiac surgery population. METHODS: A retrospective study was completed on cardiac surgery patients (N = 150). A modified preoperative PONV risk assessment tool was utilized to identify patients at high and low risk for PONV. RESULTS: 54% of the high-risk group versus 13% of the low-risk group experienced ≥2 nausea events in the early post-operative period (p < 0.0001). The high-risk group had a uniquely elevated and sustained number of PONV events post-operatively. History of PONV (p = 0.03) and female gender (p = 0.01) emerged as significant predictors of any nausea event. CONCLUSIONS: A specific PONV risk assessment tool may be useful for predicting those at highest risk following cardiac surgery. Further research is required to identify strategies to reduce PONV.

Prehabilitation program for elective coronary artery bypass graft surgery patients: a pilot randomized controlled study.

OBJECTIVE: To determine the feasibility of a cardiac prehabilitation (Prehab) program for patients waiting for elective coronary artery bypass graft (CABG). DESIGN: A two-group parallel randomized controlled trial. SETTING: Medical fitness facility. SUBJECTS: Seventeen preoperative elective CABG surgery patients were randomized to standard care (n = 9) or Prehab (n = 8). INTERVENTION: Standard care: three-hour preassessment appointment. Prehab: exercise and education classes for 60 minutes/day, twice weekly for at least four weeks. MAIN MEASURES: Data were collected at baseline, one week preoperatively, and three months postoperatively. The primary outcome measure was walking distance using a 6-minute walk test. Secondary outcome variables included 5-meter gait speed, and cardiac rehabilitation attendance three months postoperatively. RESULTS: Fifteen patients (standard care, n = 7; Prehab, n = 8) completed the study. No Prehab patients developed cardiac symptoms during study participation. Walking distance remained unchanged in the standard care group; whereas, the Prehab group increased their walking distance to mean ± SD 474 ±101 and 487 ±106 m at the preoperative and three month postoperative assessments (p < 0.05). Gait speed was unchanged in the standard care group, but improved in the Prehab group by 27% and 33% preoperatively and three months postoperatively, respectively (p < 0.05). Enrollment in cardiac rehabilitation three months postoperatively was higher for Prehab participants (100%) than standard care participants (43%; p < 0.05). CONCLUSION: These data provide evidence for the feasibility of a Prehab intervention to improve the health status of patients waiting for elective CABG surgery. A larger trial of 92 patients will be utilized to demonstrate the safety and efficacy of Prehab.

Building emotional intelligence: a strategy for emerging nurse leaders to reduce workplace bullying.

Bullying is one of the most concerning forms of aggression in health care organizations. Conceptualized as an emotion-based response, bullying is often triggered by today's workplace challenges. Unfortunately, workplace bullying is an escalating problem in nursing. Bullying contributes to unhealthy and toxic environments, which in turn contribute to ineffective patient care, increased stress, and decreased job satisfaction among health care providers. These equate to a poor workforce environment, which in turn increases hospital costs when nurses choose to leave. Nurse managers are in positions of power to recognize and address negative workplace behaviors, such as bullying. However, emerging leaders in particular may not be equipped with the tools to deal with bullying and consequently may choose to overlook it. Substantive evidence from other disciplines supports the contention that individuals with greater emotional intelligence are better equipped to recognize early signs of negative behavior, such as bullying. Therefore, fostering emotional intelligence in emerging nurse leaders may lead to less bullying and more positive workplace environments for nurses in the future.

Exploring outcomes of a nurse practitioner-managed cardiac surgery follow-up intervention: a randomized trial.

AIMS: To describe and compare the outcomes of a nurse practitioner-managed cardiac surgery follow-up model of care with the standard model of primary care provider follow-up for coronary artery bypass graft surgery patients. BACKGROUND: Advances in healthcare have had a favourable impact on length of stay following cardiac surgery; however, the shorter length of stay has not been accompanied by enhanced support to bridge the gap between acute care and the community setting. DESIGN: Prospective (2009-2010) randomized study. METHODS: Elective cardiac surgery patients (N = 200) were randomly assigned to the nurse practitioner follow-up intervention or to the standard model of follow-up care. The main outcomes were health-related quality of life, patient satisfaction, symptoms, and health resource use. Outcome data were elicited via telephone interviews at 2 and 6 weeks postdischarge. RESULTS: Baseline differences between the two groups were non-significant; however, at 2 weeks postdischarge, the intervention group reported significantly fewer symptoms and higher physical functioning status. At 2 and 6 weeks postdischarge, the intervention group was significantly more satisfied with the amount of help, as well as the quality of the services received. Differences in healthcare resource use were not statistically significant. CONCLUSION: This evidence suggests that the nurse practitioner-managed model of follow-up care effectively bridges the gap between institutional and primary care in the cardiac surgery population.