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Follow up of patients after open heart surgery
1Department of Surgery, College of Health Sciences, University of Nairobi.
Insights
Patient follow-up after heart surgery at Kenyatta National Hospital shows poor long-term adherence, with significant drop-off rates impacting cardiac care outcomes. Financial and logistical barriers likely contribute to this trend.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Postoperative follow-up is crucial for managing heart patients after surgery.
- Long-term adherence to clinic appointments can be challenging, especially in resource-limited settings.
- Understanding patient attrition is vital for improving cardiac care delivery.
Purpose of the Study:
- To determine patient dropout rates for postoperative follow-up among heart patients at Kenyatta National Hospital.
- To identify factors influencing patient adherence to long-term cardiac care appointments.
Main Methods:
- Retrospective analysis of postoperative clinic attendance for heart patients at Kenyatta National Hospital.
- Data collected over a one-year period from patient files and clinic attendance records.
- Tracing of patients lost to follow-up to refine attrition rates.
Main Results:
- Initial follow-up rates were 85% at one year, decreasing to 13% by fifteen years.
- Revised follow-up rates, including traced patients, improved to 85% (1 year), 70% (5 years), 40% (10 years), and 24% (15 years), a statistically significant difference (p=0.019).
- Valve patients demonstrated better follow-up than those with congenital heart diseases (p=0.007). Five-year follow-up for mitral, aortic, and double valve replacements were 94%, 74%, and 78% respectively.
Conclusions:
- Despite initial appearances, long-term follow-up rates for heart patients are poor, particularly when considering patient age.
- Financial constraints and logistical challenges are identified as primary reasons for patient dropout.
- Strategies to mitigate financial and logistical barriers are needed to enhance long-term patient care.
Objective:
To determine the patient drop out to postoperative follow up for heart patients at the Kenyatta National Hospital.
Design Setting And Participants:
The study analysed the postoperative attendance of heart patients to the surgical outpatient clinic at the KNH. Data on clinic attendance was collected over a one-year period from patient files and from clinic attendance.
Results:
A total of four hundred and seventy-five open heart operations have been performed at the Kenyatta National Hospital over the last twenty-five years. The patients' mean age is 18.0 years. Clinic follow up rate over this period is 85% at one-year, 62% at five-years, 32% at ten-years and 13% at fifteen-years. A number of patients who had since fallen out to clinic follow up were traced during the study period, when included into the analysis the revised figures are 85%, 70%, 40% and 24% respectively. The difference is statistically significant (p = 0.019). There was no significant statistical difference in the follow up between males and females (p = 0.278), however between patients operated for congenital heart diseases compared to valve patients, the difference was significant (p = 0.007), valve patients having a better follow up. The five-year follow up for isolated mitral, aortic and double valve replacements were 94%, 74% and 78% respectively.
Conclusion:
Despite deceptively good follow up figures, our figures are in fact poor when age is considered. Financial combined with logistical problems are the most likely causes of poor follow up.