12/17/2012 16:29 EST | Updated 02/16/2013 05:12 EST

Anxious heart-surgery patients less able to care for themselves

Lowering levels of anxiety in heart surgery patients using simple relaxation therapies could help them to take better care of themselves and reduce readmissions, a Canadian study suggests.

When heart patients are discharged home, they face challenges like following a low-sodium diet, changing bandages, taking medications and reducing their activity levels.

Patients who aren't recovering well may go to the emergency department or be readmitted for fluid overload from eating too much sodium.

Suzanne Fredericks, a nursing professor at Toronto's Ryerson University and her colleagues suspected that patients with anxiety and depression might not be able to learn and recall what they were taught about self-care before discharge from hospital.

"The actual time when the education is delivered may not be the best time because the individual may not be ready to learn that information," Fredericks said Monday.

Fredericks and her team reviewed 16 studies on the psychological condition of more than 3,700 patients in Canada, the U.S. and Europe who had coronary artery bypass grafts or valve replacement surgery.

Self-care tasks compared

At least half the patients reported moderate to severe levels of anxiety and depression when they recovered at home.

"When anxiety and depression levels changed from moderate and severe to mild, the number of self-management behaviours engaged in increased," the study's authors concluded in the November issue of the Clinical Nursing Research.

On average, those with higher levels of anxiety did one of the behaviours, such as engaging in light activity, compared with three behaviours for those with mild levels, the review of research suggested.

Fredericks recommended assessing all patients for anxiety and depression before discharge and intervening if levels are moderate to severe.

The goal is to bring down those levels before teaching the self-management goals.

The intervention could be as simple as dimming the lights and providing a quiet environment for an hour before going back in to teach the patient, Fredericks suggested.

Relaxation therapy and music could also reduce anxiety and depression in patients after heart surgery, the researchers said.

They plan to design an intervention to assess anxiety and depression before delivering self-management lessons at hospitals in Toronto and Montreal.

The study was funded by the Ontario government and Ryerson University.