Discharge Preparation Service Improves Recovery After Heart Valve Replacement

A study from the Second Hospital of Tianjin Medical University in China reports that a structured, multidisciplinary discharge preparation service, or DPS, was associated with measurably better outcomes in these patients, including higher discharge readiness, stronger self-management, improved quality of life, and lower rates of unplanned readmission and complications.

The retrospective cohort study included 323 patients who underwent heart valve replacement surgery between February 2023 and January 2025. The research team first built the DPS plan through a modified Delphi method, a structured process in which a panel of experts reviews and scores proposed care items over successive rounds until agreement is reached. Every item in the final plan reached consensus, with average importance scores of at least 4.0 and coefficients of variation no higher than 0.25, indicating that expert ratings were both favorable and consistent. Agreement across the panel was strong, reflected in a Kendall’s coefficient of concordance W of 0.925, and the expert authority coefficient was 0.914.

Once the plan was implemented in clinical practice, the researchers compared patients who received the service with those who received usual care. Because patients were not randomly assigned, the team used 1:1 propensity score matching to reduce bias, pairing each DPS patient with a control patient of similar baseline characteristics. After matching, 110 patients in each group were analyzed, and no significant differences remained between the groups in baseline characteristics, with P values above 0.05 and standardized mean differences below 0.1.

Discharge readiness and the quality of discharge teaching were assessed at the time of discharge using the RHDS and QDTS instruments. Patients in the DPS group scored significantly higher on both measures than patients in the control group, suggesting that the service left them better prepared to manage recovery at home.

Linear mixed models, which account for repeated measurements in the same patients over time, examined the effects of time, group, and the interaction between the two. For all three measures, the time-by-group interactions were significant: F(2,436) = 77.73 for CSMS, F(2,436) = 93.92 for CCQQ, and F(2,436) = 67.53 for NSNS, all with P values below 0.001. These interaction terms indicate that the improvement trajectories over the six months were steeper in the DPS group than in the usual care group.

The interaction estimates at that point were 11.23 points for CSMS, 15.61 points for CCQQ, and 10.40 points for NSNS, with 95 percent confidence intervals of 9.23 to 13.23, 13.36 to 17.86, and 8.60 to 12.20 respectively, all statistically significant. In practical terms, patients who had gone through the discharge preparation service continued to improve faster in self-management and quality of life throughout the follow-up period.

The service was also associated with fewer adverse events. Unplanned readmission occurred in 6.36 percent of the DPS group compared with 15.45 percent of the control group, a difference that reached statistical significance at P = 0.031. Total complications were recorded in 25.45 percent of DPS patients versus 59.09 percent of controls, a difference significant at P < 0.001.

Several features of the study design deserve attention when weighing these results. The Delphi process gave the DPS plan a structured, expert-validated foundation, and propensity score matching helped ensure that the two groups started from comparable baselines. The use of validated instruments, repeated follow-up measurements, and mixed-effects modeling strengthens the internal analysis. However, because the study was retrospective and observational rather than randomized, it can show association but cannot definitively prove causation. Unmeasured differences between patients who received the service and those who did not could still have influenced the outcomes.

The authors conclude that the systematic, multidisciplinary DPS plan was associated with significant improvements in discharge readiness, self-management ability, and quality of life, along with lower rates of unplanned readmissions and complications after heart valve replacement surgery.

Subject of Research: Development and evaluation of a multidisciplinary discharge preparation service for patients after heart valve replacement surgery.

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

Article References: Zhang, C., Yu, H., Zhai, W., Zhang, L., Zhang, T., & Li, Y. (2026). Study on the construction and application effect of discharge preparation services in heart valve replacement surgery. Frontiers in Cardiovascular Medicine, 13, 1879911. https://doi.org/10.3389/fcvm.2026.1879911

Image Credits: AI Generated

DOI: 10.3389/fcvm.2026.1879911

Keywords: discharge preparation service, heart valve replacement surgery, discharge readiness, self-management, quality of life, unplanned readmission, propensity score matching, retrospective cohort study, modified Delphi method, cardiovascular nursing, construction, application