Every year, over 30,000 people in the UK have cardiac surgery, but one in four valve surgery patients and one in six coronary artery bypass patients are readmitted to hospital within a year—and no one has systematically tracked why or what happens to them after discharge. This matters because patients report feeling “alone” and “abandoned” once they leave the hospital, yet there is no clear picture of the care they receive, when readmissions occur, or what aftercare might prevent them. The CARE project will map the full post-surgery journey using linked hospital, GP, and mortality data, survey all UK cardiac surgery centres about their current aftercare practices, and interview patients and families about what they actually need. If successful, this work will produce the first evidence-based blueprint for a cardiac surgery aftercare package—something that currently does not exist. That could reduce preventable readmissions, improve quality of life for tens of thousands of patients each year, and give the NHS a practical, tested model for supporting people after major heart surgery. The project is designed to lead directly to a larger trial of that aftercare package.
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Background Over 30,000 people undergo cardiac surgery in the UK every year. Cardiac surgery has excellent in-hospital outcomes, but 1 in 4 people having valve surgery and 1 in 6 people having coronary artery bypass grafts (CABG) are readmitted in the year after their operation. Patients told us they felt "alone" and "abandoned" when they went home after cardiac surgery. There is no information as to when or why readmissions occur, or what care is provided to people following discharge from their surgery. Aims and objectives The overall aim of this Programme Development Grant is to undertake work that will allow us to identify the best approach to improve care after hospital discharge for people having cardiac surgery. Specific objectives (with associated Developmental Work Packages – DWPs) are to: Describe the longitudinal care pathway of people who have cardiac surgery, from discharge to further diagnosis/treatment/care, hospital readmission and survival (DWP1). Identify aftercare plans (if any) and healthcare staff perceived need for patients having cardiac surgery (DWP2). Identify what aftercare patients, families and carers want after cardiac surgery and what the barriers are to accessing it (DWP3). Identify the best approach to prevent readmissions and improve quality-of-life for patients after cardiac surgery and design research that addresses this (DWP4). Methods We will use the existing infrastructure from our FitForHeartOp Programme Grant to efficiently answer the objectives above. DWP1. Retrospective, longitudinal cohort study using linked Hospital Episode Statistics (HES), Clinical Practice Research Datalink (CPRD) and Office for National Statistics mortality data. We will identify people who had cardiac surgery in HES using OPCS codes and map their longitudinal care pathway in linked CPRD data. DWP2. Structured questionnaire administered to UK cardiac surgery centres asking about care delivered after surgery in preparing for- and after-discharge from hospital. We will also ask about perceived gaps in aftercare. DWP3. Semi-structured interviews with 20-24 patients and their family members (including "before and after" surgery interviews with patients who have been interviewed about prehabilitation for our FitForHeartOp Programme). DWP4. One-day stakeholder meeting to present the findings from DWP1-3. Participants will develop a draft logic model for aftercare factors that influence readmission and quality-of-life after cardiac surgery and decide on an aftercare package and how this should be developed and tested. Timelines for delivery 16 months: DWP1: Months 1-12; DWP2: Months 1-6, DWP3: Months 1-14; DWP4: Months 13-16. Patient and Public Involvement and Engagement (PPIE) This work emerged from patient contributors to our FitForHeartOp Programme. The group have and will continue to be contribute to all stages of the research. Equality, Diversity and Inclusion (EDI) We will use the EDI Research toolkit we developed for the Royal College of Surgeons. Specifically: DWP1 includes allpatients who have undergone heart surgery in England and Wales, and we will use evidence-based inclusivity approaches to recruit interviewees, PPIE and stakeholders. Anticipated impact and dissemination We will publish in journals, scientific meetings and to other patient groups, specialist societies, and by direct input to NHS England s Cardiac Services Programme.
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