Every year, more than 10,000 patients in the Netherlands undergo heart surgery. The underlying conditions are partly related to lifestyle-related risk factors such as smoking, inactivity, unhealthy diet and stress. These factors also influence perioperative risk, postoperative recovery and long-term cardiovascular outcomes. However, most lifestyle counselling sessions only start six to eight weeks after the procedure, during cardiac rehabilitation. Within the DCVA, the Eerder Beter project group has mapped out the care pathways and patient experiences across ten Dutch heart centres. This analysis shows that the period before surgery – currently often a passive waiting period – offers an important, as yet untapped opportunity for lifestyle advice.
Based on the inventory, the Eerder Beter project group, in collaboration with Coalitie Leefstijl in de Zorg, has drawn up a report. This report describes how heart centres can integrate lifestyle advice sustainably and effectively into the perioperative care pathway for elective heart surgery (coronary artery bypass grafting (CABG) and aortic valve replacement (AVR)), so that patients are better prepared for surgery, recover more quickly and live healthier lives.
Similarities, differences and opportunities for lifestyle support
Researchers from Heartbeat Ventures mapped out the care pathways and patient experiences in ten heart centres. The analysis revealed several moments and themes in which lifestyle plays or could play a role. For example, all centres have similar steps, such as heart team consultations, a pre-operative clinic that is often organised as a carousel model – in which the patient sees different healthcare providers on a single day – and a focus on mobilisation and protein-rich nutrition to support recovery after surgery. Several hospitals also have a lifestyle desk (leefstijlloket), although this is rarely integrated into the cardiac surgery care pathway.
At the same time, there are clear differences between centres in terms of waiting times, contact moments, provision of information and use of e-health. The analysis shows that there are also significant opportunities here for lifestyle integration, such as making better use of digital support, referrals to primary care providers and the local network, using the physical care environment and involving the social environment. Contact moments can also be better utilised to discuss the importance of lifestyle in a timely and repeated manner.
Patient experiences
Conversations with patients show that they need clear and practical information that is relevant to their own situation. Many patients experience stress and uncertainty in the period leading up to surgery. The support of loved ones plays an important role in this period.
Patients are eager to know what they can do themselves to prepare properly and indicate that they like to be able to practise close to home. Peer support is considered valuable by many patients, because recognition and mental support can contribute to motivation. At the same time, the need for information varies greatly: some patients want to know everything, while others want to know as little as possible because of fear.
Heart surgery as a teachable moment
The survey was conducted using the Teachable Moment guide from Coalitie Leefstijl in de Zorg. During such a teachable moment, people are more open to changing their lifestyle. Surgery is such a moment. Read more about teachable moments or download the guide Teachable Moment surgery
Proposal for integrating lifestyle into the care pathway: Eerder Beter blueprint
The report also proposes a blueprint for a care pathway, with a view to integrating lifestyle sustainably and effectively into the perioperative care pathway for planned heart surgery.
Some elements of this recommendation are:
Cardiologist, Leiden University Medical Centre: “‘The report gives us, as the CTC team Leiden-Basalt, new insights into the multidisciplinary care pathways surrounding heart surgery, in which both intramural and extramural forces are combined to offer patients the most appropriate care. It is very useful to be able to look into each other's workplaces!’’
Cardiothoracic surgeon, Catharina hospital: “A successful heart operation does not start in the operating room, but well before that – with careful preparation. In this report, we show how we, as a cardiac surgery team, from surgeons to nurses and from primary care to rehabilitation, can jointly contribute to optimal preparation of the patient and to a sustainable, healthier recovery afterwards.”
The report is available (in Dutch) on request via info@dcvalliance.nl
