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- Page navigation anchor for RE: Management of CABG patients. Dr. J Joel JeffriesRE: Management of CABG patients. Dr. J Joel Jeffries
Dear Dr. Jeffries
I am happy to hear that you have had a successful CABG X2. Unfortunately the symptoms/complications that you experienced are not uncommon as we have mentioned "Pain is often related to mechanical trauma from the sternotomy, in which case it is localized and exacerbated by movement. ", as well as Appendix 2 of the supplemental material.
You make very good recommendations. I would like to highlight, that one of the goals through this paper, is that in the immediate post-operative period, the primary care physician should have a low threshold to call the cardiac surgeon and not the cardiologist. After the initial recovery period, the cardiologist is again essential to monitor for future symptoms of angina etc.
I am a big fan of your final recommendation! Since health care is provincially regulated and funded (and resource dependant) not all programs in Canada have the luxury you had to be able to have a daily call with the cardiac team after discharge. That doesn't mean we shouldn't strive for that - I would see that as a GOLD STANDARD in post-cardiac care.
Competing Interests: Final author of original manuscriptReferences
- Dominique de Waard, Andrew Fagan, Christo Minnaar, et al. Management of patients after coronary artery bypass grafting surgery: a guide for primary care practitioners. CMAJ 2021;193:E689-E694.
- Page navigation anchor for Kellie D. Scott [MD, CCFP, FCFP] comment responseKellie D. Scott [MD, CCFP, FCFP] comment response
Dr. Scott makes a good point regarding authors being providers in the field of the work published. I would like to bring to your attention that Dr. Christo Minnaar (MBChB, CCFP(EM), FCFP) has been a primary care provider and family physician for more than 20 years, now dedicating himself as Chief of Staff at Bethesda Hospital. Dr. David Horne (MBChB, DCH, FRCS(C)) was a family physician for 11 years before retraining in cardiac surgery. Arguably, who has a better perspective than someone who has lived both the family physician and the cardiac surgery speciality life? This manuscript was born out of the findings from the above 2 authors' abstract in 2012 (2), when it became evident from a small survey project in Manitoba, that family physicians have been neglected in education on the topic of post-cardiac surgery care. The final author has also done more than 50 invited lectures on the topic to family physicians' practices, family physician-, internal medicine- and cardiology conferences across Canada. Rest assured that the editors of CAMJ did in fact do due diligence during the peer review process to ensure that the authors are actually authentic with family physician backgrounds and appropriate representatives to author this paper.
Secondly, regarding "mechanical chest pain, graft site pain or parasthesias", I urge you to look at "Appendix 2. Table 1: Characteristics and important considerations of surgical wounds after cardiac surgery...
Show MoreCompeting Interests: Corresponding author of original manuscript.References
- Dominique de Waard, Andrew Fagan, Christo Minnaar, et al. Management of patients after coronary artery bypass grafting surgery: a guide for primary care practitioners. CMAJ 2021;193:E689-E694.
- Horne D, Minnaar C, Hiebert B, Arora RC, Singal RK. Post-Cardiac Surgery Care: What does the family physician know? Canadian Journal of Cardiology, Volume 28 (2012), p S399
- Page navigation anchor for RE: A Guide for Primary Care PractitionersRE: A Guide for Primary Care Practitioners
To the Editors and Authors,
Thank you to the authors for summarizing common complications post CABG. The content is a good summary of issues that cardiac surgeons or cardiologists are likely to hear about from their patients following CABG surgery.
However, none of the authors appear to be primary care practitioners. Many of the actual practical considerations and longer term sequelae that patients discuss with their primary care providers post-CABG were overlooked. Examples include mechanical chest pain, graft site pain or parasthesias, cost and side effects/intolerance of new medications started, return to the gym or work or activities (accepting that not all patients have access to cardiac rehab), depression/grief, anxiety in the patient and in family members, and sexual function. Increased risk of pneumonia is addressed, but consideration of pneumococcal vaccination as a prevention strategy is not.
In future, I hope the Editors will ensure that any articles proposed as a guide for a particular type of practitioner include one of these practitioners as an author to ensure relevancy of the article for the intended audience. I doubt the journal would publish a guide for Otolaryngologists written by Family Physicians or Neurosurgeons. The same principles of engagement of patient voices you have taken conscious effort to seek out and include can be applied here to clinician perspectives.
The August 2021 CMAJ issue that this article is pub...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: management of CABG patientsRE: management of CABG patients
August 13, 2021
Editor, CMAJ
I am prompted to respond to the article Management of patients after coronary artery bypass grafting surgery: a guide for primary care practitioners.
I have compared my own experience 14 months ago when I had double bypass with the typical outcomes detailed in the article.
I was not readmitted within 30 days as occurs in patients over 80 ( I was 81).
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I did not develop cardiac tamponade which occurs in 1% to 12.6% of patients.
I did not have a perioperative myocardial infarction which occurs in 0.6% to 19% of patients.
I have not had a graft occlusion which occurs in 2% to 5% of patients per annum.
I did not develop pneumonia which occurs in 2.4% of patients.
I did not have any cognitive dysfunction which affects 50% to 70% of patients. I did not develop depression, euphoria or anxiety.
I did not have post-operative delirium which impacts 73% of patients.
I did not develop kidney dysfunction which affects 30% of patients.
I did not develop atrial fibrillation which affects 30% of patients.
Not seeing a GP within 30 days is associated with 5 times worse outcomes. I did not get to see my GP within 30 days because of Covid-19 nor have I seen her yet although I have had best possible care by telephone.
It therefore appears that my outcome was remarkably good for which I am very thankful. Two factors may have helped: for an electrophysiology study I was kept in...Competing Interests: None declared.References
- Dominique de Waard, Andrew Fagan, Christo Minnaar, et al. Management of patients after coronary artery bypass grafting surgery: a guide for primary care practitioners. CMAJ 2021;193:E689-E694.