The feasibility and potential impact of CArdiac Brief INtervention (CABIN) on patients following ST-elevation myocardial infraction: a pilot randomised controlled trial

Abstract Background An ST-elevation myocardial infarction (STEMI) induces emotional distress and cardiac misconceptions for some patients which may impede subsequent participation in cardiac rehabilitation (CR). To address these issues, CArdiac Brief INtervention (CABIN) was co-designed with patients and clinicians in the United Kingdom (UK). Purpose To examine the feasibility and potential impact of CABIN, a nurse-led, short (approximately 20 minutes) emotional and educational support discussion with a patient, along with a tailored, educational leaflet. Methods A pilot randomised controlled trial employing a mixed-method approach was conducted. The required sample size was number (n) = 40 patients and eligibility criteria were confirmed diagnosis of a STEMI, ≥ 18 years, and no physical or mental impediments (i.e., inability to talk or read) to participation. Patients were recruited from coronary care units at two hospital centres in the UK, with participants randomised (1:1) to the intervention or control group. CABIN was delivered by a member of the research team (experienced cardiac nurse) to the intervention group prior to discharge. The control group received standard care information. Data were collected at baseline, post-intervention, 4 weeks, and 14 weeks. Quantitative (i.e., checklists and evaluation forms) and qualitative data (semi-structured interviews) were collected to inform feasibility measurements and process evaluation. Participants completed validated questionnaires at each timepoint, which assessed disease knowledge along with psychological and emotional well-being (see Figure 1). CR enrolment data were also collected. Quantitative data were analysed with descriptive statistics and qualitative data were examined using framework analysis. Results The required sample size (intervention: n = 20, control: n = 20) was achieved over 12 weeks (recruitment rate: approximately 13 patients per month). Average intervention delivery time was 21.5 ± 4.0 minutes. The overall drop-out rate was 12.5% (n = 5 patients). Average ages were 62.4 ± 11.0 and 64.7 ± 11.5 for the intervention and control groups, respectively, with both groups being predominantly male and all participants were white. Both groups reported agreement for the suitability of the study / intervention design, delivery, and treatment. The intervention group demonstrated more favourable scores across all patient-related outcomes at each timepoint (see Figure 1), along with greater attendance at CR (intervention group: 100% CR enrolment, control group: 50% CR enrolment). Four key themes with a central foundation of ‘Psychoeducational Support’ were identified from the qualitative data (see Figure 2). Conclusion CABIN is feasible for patients, with preliminary data indicating a potential for this intervention to enhance disease knowledge and psychological well-being, whilst encouraging CR enrolment. Future work will advance CABIN to effectiveness and implementation testing.Figure 1 Figure 2