The Post-acute Care for Cardiovascular Disease
The Post-acute Care for Cardiovascular Disease
Aim: The aims of this study are 1) to determine the demand of post-acute care among patients
 with cardiovascular disease in China; 2) to identify the details of demands especially which
 have value for the post-acute care for patients with cardiovascular disease.

 Design: A single center prospective cohort study. Methods: Patients will be enrolled from the
 department of cardiology in a tertiary teaching hospital. The data on the demands of
 post-acute care will be collected throughout the hospitalization and discharge. Patients with
 cardiovascular disease will be followed up for 3 months. The study was approved by the ethics
 committee in August 2020.

 Discussion: Post-acute care is very important for the short- and long-term outcomes of the
 patients with cardiovascular disease. This study will provide an effective tool for the
 investigation of the detailed demands for post-acute care in cardiovascular disease and
 provide a better understanding of the demands for the patients with cardiovascular disease.

 Impact: In clinical practice, understanding of the demands for post-acute care of the
 patients with cardiovascular disease can help nurses implement effective strategies at the
 early stages to patients to improve the short- and long-term outcomes of the patients. The
 follow-up results will help us better understand the impact of a post-acute care system on
 patients' outcomes.

 Keywords: Post-acute care, Cardiovascular disease, nursing, protocol
1. INTRODUCTION China has entered the high-pressure period of cardiovascular disease. The
 incidence of cardiovascular disease is still rising. It has become a great threaten for
 the health of Chinese resident and the social economy development. The comprehensiveness
 and complexity of the influencing factors of cardiovascular disease determine the
 long-term and arduous task of prevention and treatment. It is necessary to coordinate
 the resources of all parties and improve the mechanism of comprehensive prevention and
 treatment of cardiovascular disease with multi department cooperation. At present, due
 to the limited medical resources, high cost of hospitalization and the shortage of
 hospital beds, the average length of stay of patients is gradually shortened, resulting
 in an increasing number of patients with cardiovascular disease who are discharged
 immediately after acute treatment. Although the emergency problems of the disease have
 been solved during hospitalization, there is still a period of transition in the process
 of rehabilitation before returning to the family and society. Therefore, long-term and
 systematic management after discharge is the most important measure to improve the
 prognosis of patients with cardiovascular disease. Post-acute care (PAC) is the most
 important guarantee to provide continuous medical care for patients with cardiovascular
 diseases. Readiness for hospital discharge is the key link between emergency care and
 post-acute care, which helps to shorten the length of hospital stay, reduce the rate of
 readmission, improve the quality of life of patients with cardiovascular diseases and
 reduce medical costs. In recent years, China's post-acute care system has made a series
 of achievements, but it is still distributed in the form of dots, and there is no mature
 working mode. Therefore, it is urgent to build a characteristic post-acute care system
 for cardiovascular diseases based on China's national conditions. However, Understanding
 the details of patients' demands is the key and the first step in building the
 post-acute care system for cardiovascular diseases. This study will provide an effective
 tool for the investigation of the detailed demands for post-acute care in cardiovascular
 disease and provide a better understanding of the demands for the patients with
 cardiovascular disease.

 2. THE STUDY 2.1 Aims The aims of this study are 1) to determine the demand of post-acute
 care among patients with cardiovascular disease in China; 2) to identify the details of
 demands especially which have value for the post-acute care for patients with
 cardiovascular disease.

 2.2 Study Design This is a single-center, prospective cohort study conducted at a tertiary
 teaching hospital in Shanghai, China.

 2.3 Setting The study will be conducted in the cardiology department in Zhongshan hospital,
 Shanghai, China, which is the largest hospital in Shanghai with 2005 beds.

 Cardiology department focuses on interventional diagnosis and treatment of complex and
 difficult cardiovascular diseases with 527 beds and 503 nurses and physicians. Approximately
 more than 24000 patients per year are admitted, including angina pectoris, acute myocardial
 infarction, atrial fibrillation, atrial flutter, premature ventricular contractions,
 atrioventricular block, sick sinus syndrome, pulmonary hypertension, congenital heart
 disease, rheumatic heart disease, valvular disease, heart failure, cardiomyopathy,
 myocarditis, etc.

 2.4 Participants Inclusion Criteria Patients with cardiovascular disease aged above 18. The
 patients are aware of the disease condition. The patients can read and understand
 independently and participate in this study voluntarily.

 Exclusion Criteria The patient's condition is critical and life-threatening. People who are
 not conscious or are not cooperative by mental disorders. Patients refused to continue to
 participate in the study.

 2.5 Sample size Our study will aim to identify demands for the post-acute care of patients
 with cardiovascular disease. According to the rule of thumb, the sample size should be 5-10
 times the number of items of questionnaire. Considering the 20% loss rate, the sample size is
 required to be at least 900 cases, and 1000 cases are preliminarily planned to be included in
 our hospital.

 2.6 Data collection Demands for post-acute care Data of the demands for post-acute care will
 be collected face to face or telephone, including guidance of rehabilitation exercise,
 medication, diet, introduction of available social resources support, such as long-term care
 insurance, etc. Demographic characteristic The demographic variables and related information
 on the demands of post-acute care will also be collected, including gender, age, marital
 status, education level, work status, family per capita monthly income, type of medical
 insurance, distance between home and hospital, main diagnosis, duration of illness, pipeline
 indwelling, length of hospital stay, hospitalization treatment, medication, the destination
 after discharge, etc.

 Readiness for hospital discharge scale (RHDS) The original scale was developed by Weis et al.
 It has 4 dimensions: self-condition, disease knowledge, coping ability after discharge,
 social support available, and 23 items. The first question is not included in the total
 score. The rest items are scored by 0-10 points. The score of "0" represents "not knowing at
 all" and "completely unable", and "10" stands for "completely knowing" and "completely
 capable". Patients can choose the appropriate score according to their own situation. The
 higher the score, the better the readiness for discharge. This study adopts the Chinese
 version of Zhao et al. of West China Hospital of Sichuan University.

 2.7 Data management All the data will be entered and stored in the Research Electronic Data
 Capture (REDCap), which will be securely locked, and password protected. It is supported and
 maintained by the Evidence-based center of Fudan University. Data management and analysis,
 including data audit, import and tracking will be done by the biostatisticians in the center.
 Each patient will be given a study identification number; all paper files will be imported to
 the database once completed.

 2.8 Statistical analysis Chi square test was used for categorical data, t-test and ANOVA were
 used for measurement data. Through univariate, multivariate analysis, structural equation
 model and path analysis, the relationship between readiness for hospital discharge and
 demands of patients for post-acute care was analyzed.

 2.9 Ethical considerations This study was approved by the Hospital Ethics Board in August
 2020 (SK2020-014). The study will be conducted in accordance with the International Council
 for Harmonization and Good Clinical Practice principles. The study will adhere to the ethical
 principles stated in the Declaration of Helsinki.

 All patients will receive written and verbal information of the study before surgery. Written
 informed consent will be obtained before inclusion. Patient have the right to withdraw from
 the study at any time. Data collection will be stopped, and patients' record will be deleted
 from the database if a patient withdraws from the study.

 2.10 Validity, reliability and rigor In this study, we will use one instrument named RHDS.
 The validity and reliability will be tested with the baseline data. The cohort study will
 follow the STROBE statement.
Inclusion Criteria:

 Patients with cardiovascular disease aged above 18. The patients are aware of the disease
 condition. The patients can read and understand independently and participate in this study
 voluntarily.

 Exclusion Criteria:

 The patient's condition is critical and life-threatening. People who are not conscious or
 are not cooperative by mental disorders. Patients refused to continue to participate in the
 study.