Study on the construction and application effect of discharge preparation services in heart valve replacement surgery

Q: What are the key findings of this study?

Multidisciplinary discharge preparation services improved 6-month self-management ability (MD 11.23, P<0.001) and reduced unplanned readmissions (6.36% vs. 15.45%, P=0.031) after valve replacement.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Valvular heart disease undergoing heart valve replacement surgery (n=220). Intervention: Multidisciplinary Discharge Preparation Service (DPS) vs. Routine postoperative nursing care and follow-up. Primary outcome: Self-management ability (CSMS score time × group interaction estimate at 6 months) (MD 11.23, 95% CI 9.23-13.23, p=<0.001).

Q: What does this research mean for the field?

A multidisciplinary discharge preparation service improves 6-month self-management ability and reduces unplanned readmissions and complications following heart valve replacement surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To develop a multidisciplinary discharge preparation service (DPS) and evaluate its effects on discharge readiness, quality of life, and clinical outcomes following heart valve replacement surgery.

Chunyan Zhang; Huan Yu; Wei Zhai; Lili Zhang; Ting Zhang; 李媛媛

doi:10.3389/fcvm.2026.1879911

October 30, 2026Frontiers in Cardiovascular MedicineOpen Access

Study on the construction and application effect of discharge preparation services in heart valve replacement surgery

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Key result

Multidisciplinary discharge preparation cuts unplanned readmissions by ~9 percentage points after heart valve replacement.

MD −11.23
95% CI 9.23-13.23
P<0.001
n=220

Why the study?

The study aimed to develop and evaluate a multidisciplinary discharge preparation service for patients after heart valve replacement surgery.

Does a multidisciplinary discharge preparation service (DPS) plan improve discharge readiness, self-management ability, quality of life, nursing satisfaction, and reduce unplanned readmissions and complications in patients undergoing heart valve replacement surgery compared to routine postoperative care?

Key Points

To develop a multidisciplinary discharge preparation service (DPS) and evaluate its effects on discharge readiness, quality of life, and clinical outcomes following heart valve replacement surgery.
Developed a multidisciplinary DPS scheme covering admission through 6 months post-discharge using a modified Delphi method with 16 experts across six medical specialties.
Conducted a retrospective cohort study of 323 patients who underwent heart valve replacement surgery between February 2023 and January 2025, analyzing 110 DPS recipients and 110 usual care controls after 1:1 propensity score matching.
Assessed readiness for discharge (RHDS) and discharge guidance quality (QDTS) at discharge, and evaluated self-management (CSMS), quality of life (CCQQ), and nursing satisfaction (NSNS) at discharge and at 3 and 6 months using linear mixed models.
Compared with controls, the DPS group had significantly higher RHDS and QDTS scores at discharge (P < 0.05), alongside significant time × group interactions showing steeper improvements over 6 months for CSMS [F(2,436) = 77.73], CCQQ [F(2,436) = 93.92], and NSNS [F(2,436) = 67.53] (all P < 0.001).
At 6 months after discharge, the interaction estimates favored DPS for CSMS (11.23, 95% CI 9.23–13.23), CCQQ (15.61, 95% CI 13.36–17.86), and NSNS (10.40, 95% CI 8.60–12.20; all P < 0.001).
Patients receiving DPS experienced lower rates of unplanned readmission (6.36% vs. 15.45%, P = 0.031) and fewer total complications (25.45% vs. 59.09%, P < 0.001).

Study Design

Type

Cohort (n=220)

Multicenter

No

Structured PICO

Does a multidisciplinary discharge preparation service (DPS) plan improve discharge readiness, self-management ability, quality of life, nursing satisfaction, and reduce unplanned readmissions and complications in patients undergoing heart valve replacement surgery compared to routine postoperative care?

P

Population

220 propensity-score matched adult patients (from 323 eligible patients) who underwent single heart valve replacement surgery without perioperative neurological complications at a single center in China, followed for 6 months.

E

Exposure

Systematic, five-stage, multidisciplinary Discharge Preparation Service (DPS) plan (involving a cardiac surgeon, specially trained nurses, and a clinical pharmacist) implemented from hospital admission to 6 months post-discharge, including initial RHDS and multidisciplinary assessment, individualized goal setting, disease and warfarin anticoagulation/INR self-monitoring education, stepwise cardiac rehabilitation, nutritional and psychological screening, personalized discharge checklist, phone follow-up at 1 week, nurse-led outpatient visits at 3 and 6 months, remote INR-guided advice, and weekly WeChat education.

C

Comparator

Routine postoperative nursing care and follow-up (control group, n=110), including routine preoperative education, postoperative condition observation, medication guidance, and basic rehabilitation suggestions during hospitalization.

O

Outcome

Discharge readiness (Readiness for Hospital Discharge Scale [RHDS]) and discharge guidance quality (Quality of Discharge Teaching Scale [QDTS]) at discharge; and self-management ability (CSMS), quality of life (CCQQ), and nursing satisfaction (NSNS) assessed at discharge and at 3 and 6 months after discharge.patient reported

Main Result

Mean Difference: 11.23 (95% CI 9.23–13.23)

p-value: p=<0.001

Implementing a structured, multidisciplinary discharge preparation service significantly improves post-discharge self-management and quality of life while reducing 6-month unplanned readmissions and complications in patients undergoing heart valve replacement surgery.

Limitations

Retrospective single-center cohort design comparing non-concurrent historical control and intervention periods
No formal a priori sample size calculation was performed
Exclusion of patients with incomplete clinical data or loss to follow-up may introduce selection bias
Retrospective cohort study design
Single-center study
A formal a priori sample size calculation was not performed
Historical control comparison (February 2023–January 2024 vs. February 2024–January 2025)

Implication

May support multidisciplinary discharge preparation after valve replacement; extends observational data but leaves open randomized confirmation.

Abstract

Objective To develop and evaluate a discharge preparation service (DPS) for patients after heart valve replacement surgery. Method This retrospective cohort study included 323 patients who underwent heart valve replacement surgery between February 2023 and January 2025. A multidisciplinary DPS plan was developed using a modified Delphi method and implemented in clinical practice. After 1:1 propensity score matching, 110 patients receiving DPS and 110 receiving usual care were analyzed. RHDS and QDTS were assessed at discharge; CSMS, CCQQ, and NSNS were assessed at discharge and at 3 and 6 months after discharge. Linear mixed models examined time, group, and time × group interactions. Results All items in the DPS plan were agreed upon by experts (average importance score ≥4.0, coefficient of variation ≤0.25), with a Kendall's coefficient of concordance W value of 0.925 ( P < 0.001), and the expert authority coefficient was 0.914. After propensity score matching (PSM), there were no significant differences in baseline characteristics between the two groups ( P > 0.05, standardized mean difference <0.1). Compared with controls, the DPS group had significantly higher RHDS and QDTS scores at discharge ( P < 0.05). For CSMS, CCQQ, and NSNS, time × group interactions were significant [CSMS: F(2,436) = 77.73; CCQQ: F(2,436) = 93.92; NSNS: F(2,436) = 67.53; all P < 0.001], indicating steeper improvement trajectories with DPS. At 6 months after discharge, the interaction estimates were 11.23 (95% CI 9.23–13.23) for CSMS, 15.61 (95% CI 13.36–17.86) for CCQQ, and 10.40 (95% CI 8.60–12.20) for NSNS (all P < 0.001). DPS was associated with lower unplanned readmission (6.36% vs. 15.45%, P = 0.031) and lower total complications (25.45% vs. 59.09%, P < 0.001). Conclusion The systematic, multidisciplinary DPS plan was associated with significant improvements in discharge readiness, self-management ability, and quality of life, as well as lower rates of unplanned readmissions and complications after heart valve replacement surgery.

Discussion

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Cite This Study

Zhang et al. (2026) conducted a cohort in Valvular heart disease undergoing heart valve replacement surgery (n=220). Multidisciplinary Discharge Preparation Service (DPS) vs. Routine postoperative nursing care and follow-up was evaluated on Self-management ability (CSMS score time × group interaction estimate at 6 months) (MD 11.23, 95% CI 9.23-13.23, p=<0.001). Multidisciplinary discharge preparation services improved 6-month self-management ability (MD 11.23, P<0.001) and reduced unplanned readmissions (6.36% vs. 15.45%, P=0.031) after valve replacement.

synapsesocial.com/papers/6ae682bde432e7a5c4ef36ae https://doi.org/10.3389/fcvm.2026.1879911

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Study on the construction and application effect of discharge preparation services in heart valve replacement surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Study on the construction and application effect of discharge preparation services in heart valve replacement surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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