Educational Interventions for Coronary Artery Bypass Grafting: Reducing Anxiety and Supporting Recovery – A Narrative Review

Authors

  • Siti Aishah Hamzah Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
  • Azlina Daud Department of Medical Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
  • Thandar Soe @ Sumaiyah Jamaludin Department of Medical Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
  • Hanida Hani Mohd Mokhtar Department of Medical Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
  • Zarina Haron Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia

DOI:

https://doi.org/10.31436/ijcs.v8i3.337

Keywords:

Coronary artery bypass, Educational, Anxiety, Depression

Abstract

Background: To review evidence on educational interventions for patients undergoing coronary artery bypass grafting (CABG), with particular emphasis on educational materials such as oral explanations, videos, and other multimedia approaches, and their impact on anxiety and depression.

Methods: A narrative synthesis was conducted of 19 empirical studies, including randomised trials, quasi-experimental designs, feasibility studies, and pilot projects. Interventions covered preoperative nurse-led explanations, videos, peer-narrated clips, virtual reality tours, simulation training, smartphone or web applications, and combined education with relaxation, music, or massage. Outcomes of interest were measures of anxiety and depression, patient knowledge and satisfaction, and recovery outcome.

Results: Structured educational interventions consistently reduced preoperative anxiety across multiple settings. Video, audiovisual, and simulation formats produced reliable gains in patient knowledge and satisfaction and were often preferred to verbal or written information alone. Programmes that combined education with calming or practical supports (for example, music, relaxation, or simulation) produced larger effects on anxiety and some physiological markers. Longer or continuous interventions (web/app-based follow-up, counselling) showed greater reductions in depressive symptoms than single-session approaches. Several eHealth programmes reduced unplanned health care contacts and sped patient-reported recovery, but effects on hard clinical endpoints (ICU stay, readmission, mortality) were inconsistent.

Conclusion: Educational interventions, especially multimedia and hybrid models, help reduce anxiety and improve knowledge and recovery experience for CABG patients. Larger studies involving multiple centres with standardised outcomes and longer follow-up are needed to clarify effects on depression and clinical endpoints.

References

Tully PJ, Baker RA. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: A contemporary and practical review. Journal of Geriatric Cardiology. 2012;9(2):197–208.

Mehdipour-Rabori R, Nematollahi M. The effect of recommended Azkar on anxiety, stress, and depression in families of patients undergoing open heart surgery. Iran J Nurs Midwifery Res [Internet]. 2014;19(3):238–41. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85020307636&partnerID=40&md5=7bca533da0ad78418836e5e0a90b54d0

Pignay-Demaria V, Lespérance F, Demaria RG, Frasure-Smith N, Perrault LP. Depression and anxiety and outcomes of coronary artery bypass surgery. Ann Thorac Surg [Internet]. 2003 Jan 1;75(1):314–21. Available from: https://doi.org/10.1016/S0003-4975(02)04391-6

Ramesh C, Nayak BS, Pai VB, Patil NT, George A, George LS, et al. Effect of preoperative education on postoperative outcomes among patients undergoing cardiac surgery: a systematic review and meta-analysis. Journal of PeriAnesthesia Nursing [Internet]. 2017 Dec;32(6):518-529.e2. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85017419102&doi=10.1016%2Fj.jopan.2016.11.011&partnerID=40&md5=8ce58a04fca5db635f04a54c049280d5

Zhang CY, Jiang Y, Yin QY, Chen FJ, Ma L Le, Wang LX. Impact of nurse-initiated preoperative education on postoperative anxiety symptoms and complications after coronary artery bypass grafting. Journal of Cardiovascular Nursing. 2012;27(1):84–8.

Guo P. Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: A review of randomised controlled trials. J Clin Nurs. 2015;24(1–2):34–46.

Pakrad F, Ahmadi F, Grace SL, Oshvandi K, Kazemnejad A. Traditional vs extended hybrid cardiac rehabilitation based on the continuous care model for patients who have undergone coronary artery bypass surgery in a middle-income country: a randomized controlled trial. Arch Phys Med Rehabil [Internet]. 2021;102(11):2091-2101.e3. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85111053287&doi=10.1016%2Fj.apmr.2021.04.026&partnerID=40&md5=3abeb2ce5de92d7a7f9a01a45ce995ea

Noor Hanita Z, Khatijah LA, Kamaruzzaman S, Karuthan C, Raja Mokhtar RA. A pilot study on development and feasibility of the ‘MyEducation: CABG application’ for patients undergoing coronary artery bypass graft (CABG) surgery. BMC Nurs [Internet]. 2022;21(1). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85124415839&doi=10.1186%2Fs12912-022-00814-4&partnerID=40&md5=d62ce4107a7032bba7f6f983127e5fd7

Salzmann S, Salzmann-Djufri M, Wilhelm M, Euteneuer F. Psychological Preparation for Cardiac Surgery. Curr Cardiol Rep [Internet]. 2020;22(12):172. Available from: https://doi.org/10.1007/s11886-020-01424-9

Oliveira APA de, Souza EN de, Pellanda LC. Effectiveness of video resources in nursing orientation before cardiac heart surgery. Vol. 62, Revista da Associação Médica Brasileira. scielo ; 2016. Available from: https://doi.org/10.1590/1806-9282.62.08.762

Araújo NM de, Oliveira E dos S, Silva BVS da, Melo EBB de, Dantas RAN, Dantas DV. Audiovisual aids in preoperative cardiac surgery education: a scoping review. Vol. 31, Texto & Contexto - Enfermagem. scielo; 2022.

Habibzadeh H, Milan ZD, Radfar M, Cund A. Effects of peer-facilitated, video-based and combined peer-and-video education on anxiety among patients undergoing coronary angiography: randomised controlled trial. Sultan Qaboos Univ Med J [Internet]. 2018 Apr 4;18(1 SE-Original Studies):e61-67. Available from: https://journals.squ.edu.om/index.php/squmj/article/view/2524

Awaludin S, Nurachmah E, Novitasari D. The effect of combination prayer therapy and education on pre-operative coronary artery bypass graft anxiety. Journal of Holistic Nursing [Internet]. 2024;42(1):15–23. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85162949818&doi=10.1177%2F08980101231176906&partnerID=40&md5=bd1bee03b55fd3736eff7ddeadea251c

Nargiz Ko?ucu S, ?elimen D. Effects of music and preoperative education on coronary artery bypass graft surgery patients’ anxiety. Journal of Perianesthesia Nursing [Internet]. 2022;37(6):807–14. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133291803&doi=10.1016%2Fj.jopan.2021.12.002&partnerID=40&md5=610ba73928e61cdea534a6adb4653d6f

Kalogianni A, Almpani P, Vastardis L, Baltopoulos G, Charitos C, Brokalaki H. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery? European Journal of Cardiovascular Nursing [Internet]. 2016;15(6):447–58. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84988841181&doi=10.1177%2F1474515115602678&partnerID=40&md5=51c446def4010f80a3ff32dd6d351911

van Rijn MMMM, de Heer LMLM, Nieuwenhuis-Wendt J, van der Kaaij NPNP, Moolenaar EGEEGE, van der Ham DHDH, et al. Use of virtual reality in preoperative education of cardiac surgery patients – A feasibility study. Patient Educ Couns [Internet]. 2024;129:108394. Available from: https://www.sciencedirect.com/science/article/pii/S0738399124002611

Lai VKW, Ho KM, Wong WT, Leung P, Gomersall CD, Underwood MJ, et al. Effect of preoperative education and ICU tour on patient and family satisfaction and anxiety in the intensive care unit after elective cardiac surgery: A randomised controlled trial. BMJ Qual Saf. 2021;30(3):228–35.

Li J, Deng Y, Jiang Y. The effectiveness of a web-based information-knowledge-attitude-practice continuous intervention on the psychological status, medical compliance, and quality of life of patients after coronary artery bypass grafting surgery: a parallel randomized clinica. J Cardiothorac Surg. 2024 Mar;19(1):125.

Jeon JY, Kim DH, Kang K. Effect of audiovisual media-based nursing information on environmental stress, anxiety, and uncertainty in patients undergoing open-heart surgery. Medicine (United States). 2023;102(8):E33001.

Lee WJ, Lee MJ, Kang SG, Bang YY. The effects of video information on delirium, anxiety, and nursing satisfaction of heart surgery patients. International Journal of Bio-Science and Bio-Technology. 2016;8(6):175–84.

Rüggeberg A, Meybohm P, Nickel EA. Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives. BJA Open [Internet]. 2024; Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85191980541&doi=10.1016%2Fj.bjao.2024.100282&partnerID=40&md5=636e88d0609dbf24ef780a60e72bafb0

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj. 2021;372.

Jeon JY, Kim DH, Kang K. Effect of audiovisual media-based nursing information on environmental stress, anxiety, and uncertainty in patients undergoing open-heart surgery. Medicine [Internet]. 2023;102(8). Available from: https://journals.lww.com/md-journal/fulltext/2023/02220/effect_of_audiovisual_media_based_nursing.73.aspx

Pedramrazi S, Mohammadabadi A, Rooddehghan Z, Haghani S. Effectiveness of peer-based and conventional video education in reducing perioperative depression and anxiety among coronary artery bypass grafting patients: a randomized controlled trial. Journal of Perianesthesia Nursing. 2024; Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85186180879&doi=10.1016%2Fj.jopan.2023.12.002&partnerID=40&md5=2988d9e45040c81b31801f1cddb49727

Nargiz Ko?ucu S, ?elimen D. Effects of music and preoperative education on coronary artery bypass graft surgery patients’ anxiety. Journal of Perianesthesia Nursing [Internet]. 2022; Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133291803&doi=10.1016%2Fj.jopan.2021.12.002&partnerID=40&md5=610ba73928e61cdea534a6adb4653d6f

Awaludin S, Nurachmah E, Soetisna TW, Umar J. The effect of a smartphone-based perioperative nursing intervention: prayer, education, exercise therapy, hypnosis, and music toward pain, anxiety, and early mobilization on cardiac surgery. J Public Health Res [Internet]. 2022;11(2). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85127568273&doi=10.4081%2Fjphr.2021.2742&partnerID=40&md5=837df3b83fdfddd190ad7c710f929404

Chandrababu R, Nayak BS, Pai VB, N R, George LS, Devi ES, et al. Effects of foot massage and patient education in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial. Complement Ther Clin Pract [Internet]. 2020;40. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85087024932&doi=10.1016%2Fj.ctcp.2020.101215&partnerID=40&md5=79c32dd2dc59daedb2220da7e7efb9b4

Ertürk EB, Ünlü H. Effects of pre-operative individualized education on anxiety and pain severity in patients following open-heart surgery. Int J Health Sci (Qassim). 2018;12(4):26.

Kalkan A, Digin F. The effect of informing patients with video before cardiac surgery on intensive care experience: A randomized controlled trial. Pak J Med Sci. 2024;40(6):1067–72.

Pazar B, Iyigun E. The effects of preoperative education of cardiac patients on haemodynamic parameters, comfort, anxiety and patient-ventilator synchrony: A randomised, controlled trial. Intensive Crit Care Nurs [Internet]. 2020;58. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85078246173&doi=10.1016%2Fj.iccn.2020.102799&partnerID=40&md5=3b9147dbe9fb4daa8ec14ae2e039ca23

van Rijn MM, de Heer LM, Nieuwenhuis-Wendt J, van der Kaaij NP, Moolenaar EGE, van der Ham DH, et al. Use of virtual reality in preoperative education of cardiac surgery patients – A feasibility study. Patient Educ Couns. 2024;129.

Salehi M, Froutan R, Mazlom SR. Efficacy of the simulation-based education approach enhanced by music on anxiety, physical activity, and respiratory outcomes in patients under open heart surgery: a randomized three-group clinical study. Iran J Nurs Midwifery Res. 2024;29(5):568–76.

Farid Z, Siddiqeh M, Aziz R, Fayaz FE, Khurshid H, Khan LS, et al. Evaluation of the efficacy of cardiac surgical orientation video in decreasing preoperative anxiety in Pakistani population. Pakistan Armed Forces Medical Journal. 2020;70(4):916–22.

Tuncer M, Ye?iltepe Oskay Ü. Effect of sexual counseling on sexual function and sexual quality of life for women undergoing open heart surgery: a pilot randomized controlled trial. J Sex Med. 2023 Jun;20(7):1010–7.

van Steenbergen G, van Veghel D, van Lieshout D, Sperwer M, ter Woorst J, Dekker L. Effects of video-based patient education and consultation on unplanned health care utilization and early recovery after coronary artery bypass surgery (IMPROV-ED): randomized controlled trial. J Med Internet Res [Internet]. 2022;24(8). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85136877600&doi=10.2196%2F37728&partnerID=40&md5=ab150824e0aa2a307e27076e201b2e13

Ali A, Masih S, Rabbi F, Rasheed A. Effect of nurse led education on anxiety level among coronary artery bypass grafting pre-operative patients. J Pak Med Assoc [Internet]. 2021;71(1 B):238–42. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85110368581&doi=10.47391%2FJPMA.325&partnerID=40&md5=6bd5401e1190205d4ae5365b5dbee810

Kalogianni A, Almpani P, Vastardis L, Baltopoulos G, Charitos C, Brokalaki H. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery? European Journal of Cardiovascular Nursing [Internet]. 2016;15(6):447–58. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84988841181&doi=10.1177%2F1474515115602678&partnerID=40&md5=51c446def4010f80a3ff32dd6d351911

Chandrababu R, Nayak BS, Pai VB, N R, George LS, Devi ES, et al. Effects of foot massage and patient education in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial. Complement Ther Clin Pract [Internet]. 2020;40(June):15–23. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85087024932&doi=10.1016%2Fj.ctcp.2020.101215&partnerID=40&md5=79c32dd2dc59daedb2220da7e7efb9b4

Lai VKW, Lee A, Leung P, Chiu CH, Ho KM, Gomersall CD, et al. Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention. BMJ Open [Internet]. 2016;6(6). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84976592843&doi=10.1136%2Fbmjopen-2016-011341&partnerID=40&md5=0b6ba0d3af72e0bb31f874d3e02c7491

Heilmann C, Stotz U, Burbaum C, Feuchtinger J, Leonhart R, Siepe M, et al. Short-term intervention to reduce anxiety before coronary artery bypass surgery – a randomised controlled trial. J Clin Nurs [Internet]. 2016 Feb 1;25(3–4):351–61. Available from: https://doi.org/10.1111/jocn.13055

Haupt BA, Beauvais A. Veterans receive high-fidelity simulation education preoperatively. Clin Simul Nurs [Internet]. 2014;10(11):538–45. Available from: https://www.sciencedirect.com/science/article/pii/S1876139914001376

Downloads

Published

2025-11-30

How to Cite

Hamzah, S. A. ., Daud, A. ., Jamaludin, T. S. @ S. ., Mohd Mokhtar, H. H. ., & Haron, Z. . (2025). Educational Interventions for Coronary Artery Bypass Grafting: Reducing Anxiety and Supporting Recovery – A Narrative Review. INTERNATIONAL JOURNAL OF CARE SCHOLARS, 8(3), 186–199. https://doi.org/10.31436/ijcs.v8i3.337

Most read articles by the same author(s)

1 2 > >>