Impact of specialized nursing outpatient case management on post-coronary artery bypass grafting patients

Abstract

BACKGROUND

Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events (MACE) and require readmission after Coronary Artery Bypass Grafting (CABG) surgery. This is often attributed to patients' unhealthy lifestyles and dietary habits, inadequate understanding of the disease, and poor disease management compliance. Thus, searching for more targeted nursing intervention models that can enhance patients' self-management abilities and reduce the risk of readmission after CABG surgery is significant.

AIM

To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.

METHODS

A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample. The patients were divided into two groups using an odd-even number grouping method. The control group received routine nursing care, while the case management group received specialized nursing outpatient case management. The differences in psychological status, adherence to medical treatment, self-care ability, knowledge mastery, quality of life scores, and the occurrence rate of MACE were compared between the two groups.

RESULTS

After the intervention, the case management group had lower scores on the self-rating depression scale and self-rating anxiety scale and lower MACE rate, as well as higher scores for adherence to a healthy diet, medication adherence, good lifestyle habits, regular exercise, and timely follow-up, higher scores on the Coronary Heart Disease Self-Management Scale, higher scores for managing adverse habits, symptoms, emotional cognition, emergency response, disease knowledge, general lifestyle, and treatment adherence, higher scores for understanding coronary heart disease, recognizing the importance of medication adherence, understanding self-care points after CABG surgery, and being aware of post-CABG precautions, higher scores for physical well-being, disease condition, general health, social-psychological well-being, and work-related aspects (P < 0.05).

CONCLUSION

Specialized nursing outpatient case management can enhance patient adherence to medical treatment, knowledge mastery, psychological well-being, and overall quality of life in patients after CABG surgery.

Key Words: Specialized nursing, Case management, Coronary artery bypass grafting, Adherence to medical treatment, Knowledge mastery, Psychological status

Core Tip: This study compared the incidence of major adverse cardiovascular events (MACE) between the case management group and control group. The findings revealed a significantly lower MACE rate in the case management group (P < 0.05), suggesting that personalized nursing care can mitigate the risk of cardiovascular complications and enhance patient outcomes. These results emphasize the efficacy and benefits of the case management approach, which offer the empirical support for its wide application.

INTRODUCTION

Coronary atherosclerotic heart disease (CAHD) is a common cardiac condition primarily caused by the formation of atherosclerotic plaques within the coronary arteries. In severe cases, it can lead to sudden cardiac death and significantly impact the quality of life and overall health status of affected individuals[1]. Coronary artery bypass grafting (CABG) is an important procedure for treating CAHD and can improve myocardial ischemia. Although CABG significantly improves clinical symptoms, restores myocardial blood supply, and enhances cardiac function, some patients still experience major adverse cardiac events (MACE) and require readmission. This is often attributed to patients' unhealthy lifestyle and dietary habits, inadequate understanding of the disease, and poor disease management compliance[2,3]. Indeed, it is of great significance to search for more targeted nursing intervention models that can enhance patients' self-management abilities and reduce the risk of readmission after CABG surgery. Specialty nursing outpatient case management is a nurse-led healthcare service provided in an outpatient setting. Its main objective is to assist patients in acquiring self-management skills for chronic and specialty diseases through education and guidance. It offers a coordinated care service model that extends from the hospital to the home and from inpatient care to outpatient care, addressing the nursing needs of patients[4]. In a study conducted by El-sayed R et al[5], this nursing model demonstrated positive outcomes in managing patients with permanent pacemaker implantation. Building upon this, the aim of this study is to investigate the impact of specialty nursing outpatient case management on medication adherence, knowledge acquisition, and psychological well-being of patients after CABG surgery.

MATERIALS AND METHODS

General data

The study included 103 patients who underwent CABG surgery at our hospital from April 2021 to April 2022. The patients were divided into two groups using an odd-even number method. The control group (n = 51) received routine nursing care, consisting of 28 males and 23 females, with an age range of 18 to 75 years and an average age of (57.85 ± 9.74) years. The case management group (n = 52) received specialty nursing outpatient case management, consisting of 27 males and 25 females, with an age range of 18 to 75 years and an average age of (58.22 ± 10.14) years. The general data were compared between the two groups (P > 0.05; Table 1).

Table 1 Comparison of the general data between the two groups, n (%).

General information	Control group (n = 51)	Case management unit (n = 52)	χ2/t	P value
Sex			0.092	0.762
Male	28 (54.90)	27 (51.92)
Female	23 (45.10)	25 (48.08)
Age (mean ± SD), yr	57.85 ± 9.74	58.22 ± 10.14	0.189	0.851
BMI (mean ± SD), kg/m2	22.06 ± 2.27	21.98 ± 2.33	0.176	0.860
Number of lesion branches			0.868	0.648
Single vessel disease	12 (23.53)	15 (28.85)
Double vessel disease	19 (37.25)	21 (40.38)
Three or more lesions	20 (39.22)	16 (30.77)
Educational background			0.920	0.631
Junior high school and below	14 (27.45)	12 (23.08)
Secondary to tertiary	21 (41.18)	19 (36.54)
Bachelor’s degree or above	16 (31.37)	21 (40.38)
Concomitant disease
Hypertension	31 (60.78)	27 (51.92)	0.822	0.365
Diabetes	22 (43.14)	19 (36.54)	0.468	0.494
Smoking history	11 (21.57)	14 (26.92)	0.402	0.526
Drinking history	13 (25.49)	12 (23.08)	0.082	0.775

BMI: Body mass index.

Inclusion and exclusion criteria

Inclusion criteria: (1) Meet the "chronic stable angina pectoris diagnosis and treatment guidelines"[6] in the standard: First, with typical symptoms of angina pectoris, often induced by fatigue or emotional excitement, rest or taking nitrates can be alleviated. Second, Coronary angiography confirmed single or multiple main coronary artery stenosis, stenosis ≥ 50%; (2) Age ≥ 18 years old, ≤ 75 years old; (3) All patients underwent CABG for the first time; (4) clear consciousness, can communicate normally; and (5) The patient himself signed a written agreement.

Exclusion criteria: (1) Other cardiac-related operations, such as valve, aorta or congenital surgery; (2) With atrial fibrillation, valvular heart disease and other heart diseases; (3) Have a history of alcohol and drug abuse; (4) There was a history of thoracic surgery; and (5) Abnormal liver and kidney function or malignant tumor.

Methods

The control group received routine nursing care: Upon discharge, patients received routine discharge instructions, which primarily included medication management, follow-up appointment scheduling, and dietary guidelines. The attending physician and the primary nurse established regular telephone contact with the patients.

The case management group received specialty nursing outpatient case management: (1) A specialty nursing outpatient case management team will be formed: The team members include the department nurse manager, one supervisor nurse (with over 5 years of CABG nursing experience and certified as a health manager), two nurses (with over 3 years of CABG nursing experience and certified as health managers), and one attending physician (who oversees the patient's care during the hospital stay). After the formation of the team, they will hold meetings to discuss and develop individualized care plans based on the specific conditions, severity of illness, and treatment needs of the patients. During the management period, special attention will be given to monitoring changes in the patient's condition and ensuring adherence to dietary, exercise, and medication management; (2) Establishing an outpatient case management information database: In the outpatient specialty nursing clinic, nurses are responsible for introducing the specific management measures, purpose, and significance of specialty nursing outpatient case management to patients when they are enrolled. With the patient's consent, the nurse includes them in the management program. Building a trusting relationship with the patient, the nurse gathers detailed information about the patient's family support system, dietary preferences, exercise frequency, medication adherence, and level of disease awareness through various means. The collected patient information is organized and archived to establish a patient information database. Upon discharge, nurses establish one-on-one communication with patients through channels such as WeChat, the most widely used social software in China and mobile phones; (3) Online follow-up: After discharge, within the first week, the nursing team can send daily rehabilitation exercise videos to the patients. These videos, created by the team, primarily focus on post-operative rehabilitation exercises and precautions. Through video calls, the team can assess the healing progress of the surgical incision and provide detailed answers to any questions the patients may have during the recovery process. Starting from the second week after discharge, the team can use WeChat to send patients educational materials in the form of text and videos related to coronary heart disease management. The content can cover topics such as treatment methods for coronary heart disease, medication management, and dietary recommendations. During the follow-up period, a video call can be scheduled once a week to assess the patient's medication adherence, inquire about any adverse reactions, and understand the patient's exercise routine. Based on the patient's medication adherence and exercise habits, personalized health guidance can be provided. This may include instructions on how to take medication correctly, follow medical advice, maintain a balanced diet, and engage in moderate physical activity. The feedback provided by the patient regarding their disease can be expanded upon and corrected as necessary. Throughout the follow-up period, patients or their family members can contact the specialty nursing outpatient nurses through WeChat at any time to seek advice or ask any questions related to the treatment of coronary heart disease. The nurses will respond promptly and provide support and guidance. One week before the scheduled follow-up appointment, the nurse will contact the patient to remind them of the appointment and assist in arranging the outpatient visit. They will also provide instructions on how to prepare for the follow-up and any relevant precautions; and (4) Specialty nursing follow-up visit: During the online assessment, the nurse evaluates the patient's condition and provides specialty nursing follow-up. Through face-to-face communication, the nurse gathers information about the healing progress of the surgical incision and the level of the patient's daily functioning recovery. The nurse also assesses the patient's medication adherence and their understanding of disease-related knowledge. Addressing any issues the patient may have, such as self-adjusting medication dosage or discontinuing medication without consulting a healthcare professional, the nurse utilizes knowledge charts and shares real-life case studies to provide health education. They explain the correct use of medication, dosage, and frequency, emphasizing the importance of consulting a doctor before making any adjustments to the medication regimen. The aim is to improve the patient's adherence to medication treatment. If the patient is found to have anxiety, depression, or other negative emotions, the specialty nursing outpatient nurse will proactively communicate with the patient and provide psychological support. They will actively listen to the patient's emotions and concerns, and through positive communication and emotional support, help alleviate the patient's psychological burden. Furthermore, the nurse will encourage the patient's family members to provide necessary support and understanding to facilitate the patient's psychological recovery. After the follow-up visit, the nurse will complete relevant information and assess the patient's condition and the effectiveness of the nursing interventions. They will record the patient's recovery progress, medication adherence, psychological status, and other pertinent information. These data will be entered into the database for subsequent analysis and tracking purposes.

Scoring criteria

Mental health assessment score: The Self-Rating Depression Scale (SDS)[7] and the Self-Rating Anxiety Scale (SAS)[8] are used for assessment. The SDS includes 20 self-assessment items that measure depressive symptoms. The cutoff score of 53 is used to classify the severity of depression, with scores ranging from 53 to 62 indicating mild depression, 63 to 72 indicating moderate depression, and scores above 73 indicating severe depression. The SAS also includes 20 self-assessment items that measure anxiety symptoms. The cutoff score of 50 is used to classify the severity of anxiety, with scores ranging from 50 to 59 indicating mild anxiety, 60 to 69 indicating moderate anxiety, and scores above 69 indicating severe anxiety.

Medication adherence score: A self-developed scale specific to our hospital was used for measuring adherence. The scale demonstrates good internal consistency reliability with a Cronbach's alpha coefficient of 0.86. The scale covers five aspects of adherence: Adherence to a proper diet, timely medication intake, healthy lifestyle habits, regular exercise, and adherence to follow-up appointments. Each aspect is scored on a scale of 0 to 100, with higher scores indicating better adherence among patients who have undergone CABG surgery.

Coronary heart disease self-management scale score[9]: The evaluation assesses self-management behaviors over the past three months, covering areas such as unhealthy habits, symptoms, emotional awareness, first aid, disease knowledge, general living, and treatment adherence. The scale consists of 27 items, with each item scored on a scale of 1 to 5. The total score ranges from 27 to 135, with higher scores indicating better self-management abilities among patients who have undergone CABG surgery.

Knowledge comprehension score: A self-developed scale specific to our hospital was used for assessing knowledge comprehension. The scale demonstrates good internal consistency reliability with a Cronbach's alpha coefficient of 0.82. The scale covers four aspects: Understanding of coronary heart disease, the necessity of timely medication adherence, self-care essentials after CABG surgery, and postoperative precautions. Each aspect is scored out of 25, with a minimum score of 0. Higher scores indicate better knowledge comprehension among patients who have undergone CABG surgery.

Quality of life: The Chinese version of the Cardiovascular Patients' Quality of Life questionnaire[10] is used to assess the quality of life. The questionnaire covers six aspects: Physical well-being, symptoms, medical care, general health, social-psychological well-being, and work status. The scoring range is from 0 to 154, with higher scores indicating better quality of life among patients who have undergone CABG surgery.

MACE

As of May 30, 2023, the follow-up period ranged from 15 to 27 months. During this period, the occurrence rates of myocardial infarction, heart failure, malignant arrhythmias, cardiac readmissions, stroke, and repeat CABG were recorded for both groups.

Statistical processing

SPSS19.0 software was used for processing. Shapiro-Wilk method was used to test the normality of all measurement data (age, scores, etc.), and then (mean ± SD) was used for description. T test was used for comparison. The enumeration data (number of lesions, incidence of MACE, etc.) were described by percentage, and χ² test was used for comparison.

RESULTS

Comparison of psychological status scores between the two groups

The SDS score and SAS score of the two groups before intervention were compared (P > 0.05). The SDS score and SAS score of the two groups after intervention were lower than those before treatment (P < 0.05). After the intervention, the SDS score and SAS score of the case management group were significantly lower than those of the control group (P < 0.05; Table 2).

Table 2 Comparison of psychological status scores between the two groups (mean ± SD, scores).

Norm	Timing	Control group (n = 51)	Case management unit (n = 52)	t	P value
SDS score	Before intervention	57.01 ± 4.51	56.36 ± 4.85	0.704	0.483
	After intervention	48.78 ± 3.26a	42.95 ± 3.21a	9.145	0.000
SAS score	Before intervention	61.74 ± 4.05	62.07 ± 3.87	0.423	0.673
	After intervention	53.23 ± 3.45a	47.05 ± 3.21a	7.891	0.000

^aP < 0.05, compared with the group before intervention.

SDS: Self-rating depression scale; SAS: Self-rating anxiety scale.

Comparison of compliance scores between the two groups

Two groups were compared in terms of adherence to medical advice, including following a reasonable diet, taking medication on time, maintaining good lifestyle habits, engaging in reasonable exercise, and attending follow-up appointments punctually (P > 0.05). After intervention, the adherence scores to medical advice, including following a reasonable diet, taking medication on time, maintaining good lifestyle habits, engaging in reasonable exercise, and attending follow-up appointments punctually, increased compared to before treatment in both groups (P < 0.05). Specifically, the intervention group showed higher adherence scores to medical advice in terms of following a reasonable diet, taking medication on time, maintaining good lifestyle habits, engaging in reasonable exercise, and attending follow-up appointments punctually compared to the control group after intervention (P < 0.05; Table 3).

Table 3 Comparison of compliance scores between the two groups (mean ± SD, scores).

Norm	Timing	Control group (n = 51)	Case management unit (n = 52)	t	P value
Sensible diet	Before intervention	61.12 ± 5.71	59.98 ± 6.03	0.985	0.327
	After intervention	75.47 ± 6.89a	83.69 ± 5.78a	6.565	0.000
Take medicine on time	Before intervention	58.82 ± 6.14	59.77 ± 5.87	0.803	0.424
	After intervention	77.14 ± 6.82a	86.58 ± 7.96a	6.458	0.000
Good living habits	Before intervention	63.36 ± 5.15	62.24 ± 5.83	1.033	0.304
	After intervention	74.14 ± 6.16a	85.02 ± 5.97a	9.103	0.000
Reasonable exercise	Before intervention	52.89 ± 8.41	54.12 ± 7.76	0.772	0.442
	After intervention	70.24 ± 7.53a	82.96 ± 8.04a	8.284	0.000
Timely review	Before intervention	66.63 ± 5.87	64.97 ± 6.08	1.409	0.162
	After intervention	76.36 ± 6.96a	85.04 ± 7.71a	5.994	0.000

^aP < 0.05, compared with the group before intervention.

Comparison of coronary heart disease self-management scale scores between the two groups

The Coronary Heart Disease Self-Management Scale (CSMS) scores for adverse habits, symptoms, emotional cognition, emergency response, disease knowledge, general life, and treatment compliance were compared between the two intervention groups before the intervention (P > 0.05). After intervention, the CSMS scores for adverse habits, symptoms, emotional cognition, emergency response, disease knowledge, general life, and treatment compliance increased compared to before treatment in both groups (P < 0.05). Specifically, the intervention group had higher CSMS scores for adverse habits, symptoms, emotional cognition, emergency response, disease knowledge, general life, and treatment compliance compared to the control group after intervention (P < 0.05; Table 4).

Table 4 Comparison of coronary heart disease self-management scale scores between the two groups (mean ± SD, scores).

Norm	Timing	Control group (n = 51)	Case management unit (n = 52)	t	P value
Bad habit	Before intervention	14.89 ± 2.14	15.04 ± 1.96	0.371	0.711
	After intervention	16.01 ± 1.47a	17.52 ± 1.33a	5.469	0.000
Symptom	Before intervention	8.41 ± 1.56	8.27 ± 1.63	0.445	0.657
	After intervention	10.78 ± 1.27a	12.32 ± 1.36a	5.937	0.000
Emotional cognition	Before intervention	9.89 ± 1.24	9.77 ± 1.31	0.477	0.634
	After intervention	11.08 ± 1.36a	12.24 ± 1.42a	4.233	0.000
First aid	Before intervention	7.14 ± 1.56	7.08 ± 1.72	0.185	0.853
	After intervention	8.77 ± 1.39a	9.88 ± 1.45a	3.965	0.000
Disease knowledge	Before intervention	11.47 ± 2.08	11.53 ± 1.97	0.150	0.881
	After intervention	14.88 ± 2.42a	15.77 ± 1.98a	2.045	0.043
General life	Before intervention	11.05 ± 1.87	10.96 ± 1.93	0.240	0.811
	After intervention	14.47 ± 1.93a	15.78 ± 1.88a	3.490	0.001
Treatment compliance	Before intervention	5.87 ± 1.42	5.79 ± 1.37	0.291	0.772
	After intervention	7.54 ± 1.12a	8.25 ± 1.06a	3.305	0.001
CSMS total score	Before intervention	68.72 ± 5.16	68.44 ± 4.97	0.281	0.780
	After intervention	83.63 ± 6.96a	91.76 ± 7.14a	5.850	0.000

^aP < 0.05, compared with the group before intervention.

CSMS: Coronary heart disease self-management scale.

Comparison of knowledge mastery scores between the two groups

The knowledge mastery scores for understanding coronary heart disease, the necessity of taking medication on time, self-care essentials after CABG surgery, and post-CABG precautions were compared between the two intervention groups before the intervention (P > 0.05). After intervention, the mastery scores of knowledge regarding coronary heart disease, the necessity of taking medication on time, self-care essentials after CABG surgery, and post-CABG precautions increased compared to before treatment (P < 0.05). Among them, after intervention, the intervention group had higher mastery scores for understanding coronary heart disease, the necessity of taking medication on time, self-care essentials after CABG surgery, and post-CABG precautions compared to the control group (P < 0.05; Table 5).

Table 5 Comparison of knowledge mastery scores between the two groups (mean ± SD, scores).

Norm	Timing	Control group (n = 51)	Case management unit (n = 52)	t	P value
Understanding of coronary heart disease	Before intervention	17.85 ± 3.02	18.04 ± 2.88	0.327	0.744
	After intervention	21.12 ± 2.11a	23.65 ± 1.74a	6.645	0.000
Necessity of taking medicine regularly	Before intervention	16.52 ± 2.47	16.41 ± 2.58	0.221	0.826
	After intervention	21.53 ± 2.11a	23.74 ± 1.06a	6.736	0.000
Key points of self-care after CABG	Before intervention	14.24 ± 2.69	13.97 ± 3.78	0.417	0.678
	After intervention	20.14 ± 3.23a	23.12 ± 1.58a	5.965	0.000
Precautions after CABG surgery	Before intervention	18.85 ± 2.25	19.04 ± 2.11	0.442	0.659
	After intervention	22.05 ± 1.07a	23.74 ± 0.77a	9.214	0.000

^aP < 0.05, compared with the group before intervention.

CABG: Coronary artery bypass grafting.

Comparison of quality of life scores between the two groups

The quality of life scores for physical strength, illness condition, general health status, social and psychological well-being, work, and medical aspects were compared between the two intervention groups before the intervention (P > 0.05). After intervention, the quality of life scores for physical strength, illness condition, general health status, social and psychological well-being, and work increased compared to before treatment (P < 0.05). Specifically, the intervention group had higher quality of life scores for physical strength, illness condition, general health status, social and psychological well-being, and work compared to the control group after intervention (P < 0.05). The medical care scores of the two groups were compared before and after the interventions (P > 0.05; Table 6).

Table 6 Comparison of quality of life scores between the two groups (mean ± SD, scores).

Norm	Timing	Control group (n = 51)	Case management unit (n = 52)	t	P value
Stamina	Before intervention	27.74 ± 8.26	25.83 ± 9.54	1.085	0.280
	After intervention	32.26 ± 6.97a	38.97 ± 8.15a	4.487	0.000
State of an illness	Before intervention	14.53 ± 3.85	15.01 ± 3.94	0.625	0.533
	After intervention	17.45 ± 4.11a	20.58 ± 3.89a	3.970	0.000
Medical treatment	Before intervention	4.96 ± 0.85	4.86 ± 0.94	0.566	0.573
	After intervention	5.12 ± 0.79	5.22 ± 0.85	0.618	0.538
General condition	Before intervention	7.54 ± 1.87	7.46 ± 1.93	0.214	0.831
	After intervention	8.74 ± 1.91a	9.85 ± 1.67a	3.142	0.002
Social psychology	Before intervention	15.12 ± 2.25	14.97 ± 2.31	0.334	0.739
	After intervention	17.63 ± 2.16a	19.87 ± 2.04a	5.412	0.000
Professional	Before intervention	4.25 ± 0.98	4.19 ± 1.05	0.300	0.765
	After intervention	5.77 ± 1.12a	6.85 ± 1.24a	4.636	0.000

^aP < 0.05, compared with the group before intervention.

Comparison of MACE between the two groups

The intervention group had one case each of heart failure and malignant arrhythmia, along with two cases of recurrent hospitalization due to heart failure, resulting in a cumulative MACE rate of 7.69%. In contrast, the control group had one case each of myocardial infarction, heart failure, stroke, and repeat CABG surgery. Additionally, there were two cases of malignant arrhythmia and five cases of recurrent hospitalization due to heart failure, leading to a cumulative MACE rate of 21.57%. The cumulative MACE rate in the intervention group was 7.69%, which was lower than that in the control group, which was 21.57% (P < 0.05; Table 7).

Table 7 Comparison of major adverse cardiac events between the two groups, n (%).

MACE event	Control group (n = 51)	Case management unit (n = 52)	χ2/t	P value
Myocardial infarction	1 (1.96)	0 (0.00)
Heart failure	1 (1.96)	1 (1.92)
Malignant arrhythmia	2 (3.92)	1 (1.92)
Cardiac readmission	5 (9.80)	2 (3.85)
Cerebral apoplexy	1 (1.96)	0 (0.00)
reCABG	1 (1.96)	0 (0.00)
Cumulative MACE incidence	11 (21.57)	4 (7.69)	3.985	0.046

MACE: major adverse cardiac events; CABG: Coronary artery bypass grafting.

DISCUSSION

Arteriosclerosis, also known as atherosclerosis, is a chronic and progressive disease process. Its pathological mechanism involves the deposition of substances such as cholesterol, lipids, and calcium within the inner walls of blood vessels, particularly the coronary arteries. These deposits gradually form plaques, leading to thickening and hardening of the blood vessel walls. Eventually, the plaques can cause partial or complete blockage of the coronary arteries, restricting blood supply to the heart and resulting in a range of myocardial ischemic symptoms[11-13]. CABG is a surgical procedure that involves using the patient's own veins or arteries to create bypasses that go around narrowed or blocked sections of the coronary arteries. These grafts are implanted either above or below the affected area, allowing for the restoration of blood flow to the myocardium[14-16]. Research has shown that there is still a risk of disease progression in CABG patients post-surgery, which may be related to patients' lifestyle choices and disease management abilities. Additionally, current post-discharge nursing interventions primarily rely on communication through platforms like WeChat and phone calls, but their effectiveness is not optimal. After discharge, patients may exhibit a lack of emphasis on follow-up appointments and irregular medication use, which can negatively impact their recovery outcomes[17-19]. Therefore, in order to improve patients' treatment adherence and rehabilitation outcomes, it is necessary to provide high-quality continuity of care. Specialized nursing outpatient case management emphasizes the role of nurses in patient care, providing personalized disease management, education, and support interventions in outpatient settings and during follow-up. These interventions aim to help patients better manage their conditions, improve their quality of life, and reduce readmission rates.

CABG surgery is an invasive procedure that places certain physical stress and impact on patients, including postoperative pain and physical recovery. Additionally, after discharge, patients may face challenges such as delayed follow-up visits, inadequate nursing guidance and psychological support, or improper medication management. These issues can potentially contribute to the development of depressive and anxious emotions among patients during the rehabilitation period[20-22]. In this study, the SDS scores and SAS scores of both groups decreased after the interventions compared to before the treatment, and the case management group had lower scores than the control group (P < 0.05). This indicated that specialized nursing outpatient case management can effectively alleviate patients' adverse emotions. The reason behind this may be attributed to the detailed information collection and assessment of each patient, the development of personalized care plans tailored to individual needs and circumstances, and the better fulfillment of patients' psychological and emotional needs, thus alleviating adverse emotions[23-25]. Additionally, specialized nursing outpatient nurses help patients better understand and cope with postoperative emotional changes by providing relevant health education and psychological support. This assistance aids patients in enhancing their awareness of the disease and treatment, thereby reducing unnecessary anxiety and depression[26-28]. The results of this study also showed that both the adherence score and CSMS score increased after interventions in both groups, with higher scores observed in the case management group compared to the control group (P < 0.05). This illustrated that under specialized nursing outpatient case management, patients' comprehensive disease management abilities and treatment adherence significantly improved. This improvement can be attributed to the use of online platforms and tools, allowing the nursing team to have real-time communication and information exchange with patients. Patients can ask questions, report their condition, or seek help from nurses at any time, and nurses can promptly respond and provide support. This online collaborative management approach overcomes the limitations of time and space for patients' clinic visits, thereby enhancing the connection and closeness between healthcare providers and patients[29-31]. Moreover, regular face-to-face contact and follow-up during offline interactions further enhance the interaction and closeness between healthcare providers and patients. Through these offline encounters, nurses can conduct routine physical examinations, observe changes in patients' condition, and promptly report the recovery progress to the doctors. Additionally, offline contact provides emotional support and comfort to patients, strengthening the trust and rapport between healthcare providers and patients[32,33]. Therefore, through the collaborative management of both online and offline approaches, specialized nursing outpatient services can better meet the needs of patients and provide continuous and personalized care services.

Further analysis of the knowledge mastery scores revealed that after interventions, both groups showed increased scores in physical well-being, illness perception, general condition, social psychology, and work-related aspects compared to before treatment, with the case management group showing higher scores compared to the control group (P < 0.05). Moreover, in terms of quality of life, both groups demonstrated increased scores in physical well-being, illness perception, general condition, social psychology, and work-related aspects after interventions, with the case management group again showing higher scores compared to the control group (P < 0.05). This indicated that specialty nursing outpatient case management has a positive impact on patients' quality of life and overall health status. The case management team in the specialty nursing outpatient clinic utilizes various treatment and care approaches, including medication therapy, rehabilitation training, and nutritional guidance. These comprehensive measures effectively improve patients' condition and physical well-being, enhancing their overall health levels and enabling them to better cope with challenges and stressors in their daily lives[34]. Additionally, the weekly video consultations allow for monitoring of medication adherence, identification of adverse reactions, and assessment of physical activity. Personalized health guidance is provided to enhance patients' self-management system. This online follow-up approach enables patients to easily contact nurses, seek advice, and receive timely support[35].

This study conducted a comparison of MACE occurrence between the two groups. The results demonstrated that the MACE rate was lower in the case management group compared to the control group (P < 0.05). This indicated that individualized case management provided through this nursing model can reduce the risk of adverse cardiovascular events and improve overall patient prognosis. These findings further support the effectiveness and advantages of the case management model, providing scientific evidence for the promotion and application of this nursing approach.

CONCLUSION

In summary, specialized nursing outpatient case management can improve medication adherence, knowledge acquisition, psychological well-being, and quality of life in patients after CABG surgery. It also has the potential to reduce the occurrence of MACE in the long term.