Effectiveness of a telehealth intervention on functional status, anxiety, depression, and rehospitalization among older adults undergoing coronary artery bypass grafting: A randomized controlled trial
ABSTRACT
Background:
Telehealth has shown promise in enhancing care transitions and physical health outcomes in patients with cardiovascular disease. However, limited studies have explored its effect on functional status, psychological health, and rehospitalization, specifically in older patients undergoing coronary artery bypass grafting (CABG).
Objective:
This study aimed to evaluate the effectiveness of a telehealth intervention in improving functional status, reducing anxiety and depression, and decreasing rehospitalization rates compared with usual care among older patients undergoing CABG.
Methods:
The study was a two-arm parallel randomized controlled trial. This was conducted in two phases. Phase 1 was conducted in the cardiac surgical units at a university hospital in Bangkok, Thailand. Phase 2 involved following up with the participant at home 30 and 90 days after discharge. A total of 84 older adults undergoing CABG were randomly assigned to either the control group (n=42), which received usual care (discharge planning), or the intervention group (n=42), which received a telehealth intervention based on the Transitional Care Model in addition to usual care. The telehealth intervention included home monitoring via the “Zip Heart” application and scheduled video consultations. The primary outcome was functional status, measured using the Thai version of the Enforced Social Dependency Scale (Thai ESDS). Secondary outcomes included anxiety and depression, assessed using the Thai Hospital Anxiety and Depression Scale (Thai HADS), and rates of rehospitalization. Data were collected at baseline, 30, and 90 days after discharge. Analyses were conducted using an intention-to-treat approach, with missing outcome data handled using multiple imputation. Two-way repeated-measures analysis of variance was used to evaluate group, time, and group-by-time interaction effects.
Results:
A total of 84 participants were randomized and included in the intention-to-treat analysis (intervention group, n=42; control group, n=42). At baseline, there were no statistically significant differences between the two groups. Significant group-by-time interactions were observed for functional status scores (F(2,164)=32.09, P<.001, ηp² = .28), anxiety (F(2, 164)=20.22, P<.001, ηp² =.2), and depression (F(2,164)=16.81, P<.001, ηp²=.17). The intervention group demonstrated significantly greater improvements in functional status and greater reductions in anxiety and depression at both 30 and 90 days after discharge compared with the control group (all P<.001). Additionally, rehospitalization rates were significantly lower in the intervention group at 30 days (Z=2.77, P=.006) and between 31 and 90 days post-discharge (Z=2.31, P=.02).
Conclusions:
The Telehealth intervention is effective in improving functional and psychological outcomes and reducing rehospitalization rates among older patients undergoing CABG. Integrating telehealth into usual care can support recovery and enhance continuity of care. Clinical Trial: Thai Clinical Trials Registry TCTR20230816008;https://www.thaiclinicaltrials.org/show/TCTR20230816008
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