Abstract
The purpose of this K24 application is to provide support for the development of patient-oriented researchers in the area of outpatient monitoring of AF after cardiac surgery. Dr. Marjorie Funk proposes to spend 50% effort mentoring pre- and post-doctoral clinical scholars on this and subsequent projects. Dr. Funk's long-term career objective is to build her program of research on the wise use of technology in patient care and mentor beginning clinical investigators. Yale provides the ideal environment for her to attain her research and mentoring goals, and the School of Nursing is highly supportive of her work.
Dr. Funk's immediate research objective is to examine outpatient monitoring of atrial fibrillation (AF) in patients after cardiac surgery. AF is a common dysrhythmia following coronary artery bypass graft (CABG) and valve surgery, especially in the elderly, and is a major cause of morbidity and increased cost. It occurs postoperatively in 11% to 60% of patients, and its incidence is increasing as the age of patients undergoing surgery increases. Although AF has traditionally necessitated additional days in the hospital, length of stay has become shorter as cost constraints dictate earlier discharge. The setting of cardiac monitoring for AF, therefore, must expand from the hospital to the home.
The specific aims of the proposed prospective descriptive study are to: 1) describe the occurrence and symptoms of AF using wearable cardiac event recorders; 2) examine clinical and demographic factors associated with AF after cardiac surgery; and 3) determine the feasibility of continuous outpatient ECG monitoring.
Three hundred males and females, including minorities, who have undergone CABG and/or valve surgery will be given a cardiac event recorder to wear for 14 days following hospital discharge. They will transmit an ECG strip to a receiving center once a day and whenever they have symptoms suggestive of AF. Data on demographic and clinical factors will be recorded upon enrollment, and data on symptoms and activity with each transmitted ECG strip. Information provided by this research will be helpful in understanding the nature of postoperative AF and determining the feasibility of home arrhythmia monitoring. This information is needed to design the next study: a randomized clinical trial to test the effect of an intervention for postoperative AF.
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