https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article Effectiveness of a Health Education Program on Coronary Artery Bypass Graft Patients’ Knowledge in Surgical Specialty Hospital-Cardiac Center in Erbil City ABSTRACT Background and objective: Coronary Artery Bypass Graft is considered an important sur- gical procedure and due to the lack of sufficient knowledge in CABG patients, it is neces- sary and vital to carry out interventions to improve the knowledge of patients. Therefore, the purpose of this study is to determine the effect of a health education program on pa- tients' knowledge. Methods: This study is a quasi-experimental conducted between 2021 and 2023. The population of the study sample consisted of patients who were admitted to the cardiac center hospital in Erbil city. The samples were divided into two groups by random alloca- tion, each group of 100 people. Data collection was based on a researcher-made ques- tionnaire including three socio-demographic, medical data of patients with CABG and knowledge related to CABG. The intervention consisted of 6 sessions, which included 2 sessions of general training for patients, and 4 sessions of training including physiological aspects, self-concept, reciprocal relations and the fulfillment of obligations. Results: The mean age in the control group is 56.63±9.74 and in the intervention group is 54.32±11.123. After the intervention, the mean knowledge score in the General Infor- mation, Risk Factor, Complication, Diagnosis, and Management of Coronary Artery Bypass Grafting sections showed a significant increase among patients in the intervention group compared to the control group (P≤0.001). The results showed that the mean overall awareness score in the intervention group at the beginning of the study is lower than the average awareness score after the intervention, and this mean difference is significant (P≤0.001). The mean overall knowledge score in the intervention group has a significant difference compared to the control group (0.001). Conclusion: Considering the important effects of the educational program on increasing knowledge about various aspects of coronary artery bypass graft, educational programs should be given more attention. Keywords: Coronary Artery Bypass Graft; Education Program; Risk Factor; Co-morbidity; Diagnosis; Management. Dlzar Omer Qadir; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. (Correspondence: dlzar.qadir@hmu.edu.krd) Yousif Mohammed Younis; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. 170 Received: 01/03/2023 Accepted: 04/06/2023 Published: 30/11/2024 Copyright ©2024The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:Dlzar.qadir@hmu.edu.krd mailto:Dlzar.qadir@hmu.edu.krd?subject=Dlzar.qadir@hmu.edu.krd%20 mailto:jawdat.baker@hmu.edu.krd?subject=jawdat.baker@hmu.edu.krd%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article Cardiovascular disease (CVD), sometimes known as heart disease [1]. Coronary ar- tery disease is the greatest cause of mor- tality in the world. According to the World Health Organization (WHO), ischemic heart disease caused roughly nine million deaths in 2016 [2]. The onset of coronary artery disease is often linked to a chronic inflam- matory process, beginning with the crea- tion of a fatty streak and progressing to the formation of a fibrous atheroma [3]. This situation results in a mismatch between myocardial oxygen supply and demand [4]. Cardiovascular disease clinical manifesta- tions might range from asymptomatic to classic. [5].Coronary Artery Bypass Grafting (CABG) is an important surgical procedure in which athermanous blockages in a pa- tient's coronary arteries are bypassed with venous or arterial conduits. Bypass blood flow restores the function and viability of the ischemic myocardium, and relieves the symptoms of angina. Approximately 400,000 CABG procedures are performed annually, making it the most common ma- jor surgery [6]. Although CABG improves overall long-term mortality in individuals who meet the criteria for CABG, there is an initial operative mortality risk after CABG. The rates reported in the FREEDOM and SYNTAX trials, 1.7 percent and 3.5 percent, respectively, are consistent with conven- tional mortalities [7, 8]. Despite the ad- vantages of CABG surgery, it also has some complications, the most important of which include the following [9]. Sternal wound, SVG failure, postoperative renal failure, stroke, and atrial fibrillation. Diet, exercise and lifestyle modifications have been shown to play a potentially significant role in improving post-CABG outcomes in the few studies conducted [10] .Post-CABG discharge education and counseling ease recovery issues, lower rehospitalization rates, and medical expenses enhance patient satisfaction and quality of life (QOL), promote functional independence, and allow patients to do self-care tasks and take care of their own requirements [11, 12]. Kalogianni et al., [13] discovered that preoperative education provided by nurses decreased postoperative problems of patients undergoing heart surgery, but it was ineffective in lowering readmissions or duration of stay.It seems that due to the high prevalence of cardiovascular diseases and the lack of sufficient knowledge and awareness in coronary artery bypass graft patients, it is necessary and vital to carry out interventions to improve the awareness of patients. Therefore, the purpose of this study is to determine the effect of a health education program on the CABG patient’s knowledge in a cardiac center in Erbil city. The study employed a quantitative quasi- experimental design with a pre-test and post-test approach to examine the impact of a training program on patients admitted to the coronary care unit of a cardiac center hospital in Erbil City between 2021 and 2023. The samples were divided into two groups by random allocation. To enhance comparability between the intervention and control groups, several matching criteria were considered, including age, gender, socioeconomic status, and the severity of illness. Through random allocation, 100 patients were assigned to the intervention group, where they received the training program, while another 100 patients were assigned to the control group, where they did not receive the intervention. By incorporating these matching criteria, the study aimed to minimize potential confounding variables and strengthen the internal validity of the findings. Sample size according to the studies by P Sharma et al., [14] and K Zia et 171 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article distributed anonymously and coded. After completing the questionnaires, the sam- ples were randomly assigned to two inter- vention and control groups by means of random allocation software. The samples were divided into two groups. 100 patients were exposed to the training program as the study group, and another 100 patients were not exposed to the training program as the control group. Then, before imple- menting a real training program, the re- searcher used a questionnaire consisting of three parts, which include demographic- social data, medical data of CABG patients and knowledge related to CABG. The inter- vention of the upcoming research consist- ed of 6 sessions, which included 2 sessions of general education of patients, 4 sessions on physiological dimensions, self-concept, mutual relations and role playing, and these 4 sessions were direct interventions by the researcher in the format. By actively addressing the main and underlying factors contributing to incompatible behaviors identified in the needs assessment form, the researcher played a crucial role in help- ing every patient within the intervention groups meet their individual needs. This was achieved through the researcher's physical presence at the hospital and de- partment, ensuring personalized support and intervention for each participant. Ethical approval was achieved from the Ethics Committee of the College of Nursing/ Hawler Medical University as a code number is 145 in 7/10/2021. Permis- sion was obtained from the Director of Health/Erbil. Data analysis was reported with the assumption of normality using central indicators of mean (standard devia- tion) and frequency (percentage) for quan- titative variables. (Chi-square) test was used to check the statistically significant relationship between quantitative varia- bles. A T-test and a paired-T test were used to evaluate the effect of training al., [15] was determined. The prevalence of CABG surgery in previous studies was 70%. Accordingly, due to the same preva- lence of the disease in both groups, a sam- ple size of 81 patients was considered for each group. The calculated sample was 81 patients, which was considered to increase the strength and external validity of the study and the availability of samples for each group of 100 patients. The inclusion criteria of the study were: age above 30, ability to participate in the study, lack of prior training experience, individuals' per- sonal interest in participating in the study, an adult patient who performs CABG, and patients with stable conditions. Exclusion criteria of the study were: patients who refuse to complete the post-test, patients with mental retardation, and mental ill- nesses, patients with sensory problems such as blindness and deafness, patients with Alzheimer's people who changed their opinion about participating in the study or missed two consecutive educational inter- vention sessions for any reason. After sev- eral literature reviews and previous stud- ies, the investigator constructed the ques- tionnaire and applied it before the applica- tion of the actual educational program. It consists of three parts, which are socio- demographic, medical data of patients with CABG and knowledge related to CABG. All patients with coronary artery bypass grafts in Erbil cardiac center hospi- tal who had the conditions to participate in the study were included in the study after completing the consent form. The re- searcher explained the demographic char- acteristics questionnaire and the quality of life questionnaire to the patients, and the questionnaires were face-to-face (interview) individually for about 20-30 minutes with each patient in two sessions of the educational program before and after The test was completed using a ques- tionnaire format. The questionnaire was 172 Copyright ©2024The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article in two groups. Data were analyzed using SPSS V. 23 software. A significance level of P ≤ 0.05 was considered. Table 1 shows that the mean age of the two groups of people under investigation participants showed that the mean age in the control group is 56.63±9.7455.14±6.47 years and in the intervention group is 54.32±11.12353.21±5.41 years. The age group of patients showed that (7%) pa- tients in the intervention group and (12%) patients in the control group were in the age group of 30-39 years. (22%) patients in the intervention group and (24%) patients in the control group were in the age group of 40-49 years old. (33%) patients in the intervention group and (31%) patients in the control group were in the age group 50 -59. (27%) patients in the intervention group and (24%) in the control group were in the age group of 60-69 years, and the two groups did not differ in terms of age groups. The gender description of the pa- tients in the two groups showed that (57%) patients in the intervention group and (59%) patients in the control group were male, and the two groups had no signifi- cant differences in terms of gender distri- bution. The level of education of patients in the two groups showed that (19%) patients in the intervention and control groups were illiterate. (15%) patients in the inter- vention group and (19%) patients in the control group had the lit level reading Read and Write. Likewise, (15%) patients in the intervention group and (20%) patients in the control group had primary school grad- uates literacy. The literacy level of interme- diate school graduate was seen in (22%) intervention group patients and (16%) con- trol group patients, and the two groups had a significant difference in terms of edu- cation level (P ≤ 0.02). Occupation status of the two groups of patients, it was found that (17%) patients in the intervention group and (18%) patients in the control groups were employed, and (24.69%) pa- tients in the intervention and control group were unemployed. Other patients had the jobs of housewife, self-employed, and retired, and the two groups had a sig- nificant difference in terms of their em- ployment status (P ≤ 0.001). 88% of pa- tients in the intervention and control group returned to work after a coronary artery bypass graft. (87%) patients in the intervention group were married and (83%) patients in the control group were married, (8%) in the intervention group and (6%) in the control group were single. Patients' residential area, it was found that (83%) patients in the intervention group and (87%) patients in the control group lived in urban areas. Only (18%) patients in the intervention group had a history of smoking and (17%) patients in the control group had a history of smoking. 173 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULT https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article 174 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 1: Socio-demographic characteristics of the study sample (n= 200) Socio-demographical characteristics Class Groups P-Value* Intervention group Control group Frequency (%) Frequency (%) Age 30-39 7 (22%) 12 (12%) C.C = 0.13 P=0.1(NS) 40-49 22 (22%) 24 (24%) 50-59 33 (33%) 31 (31%) 60-69 27 (27%) 24 (54%) 70-79 10 (10%) 7 (7%) 80-89 1 (1%) 2 (2%) Mean 54.32 ± (11.123) 56.63 ± (9.74) Gender Male 57 (57%) 59 (59%) C.C = 0.02 0.886 (NS) Female 43 (43%) 41 (41%) Education Illiterate 19 (19%) 19 (19%) C.C = 0.13 0.023 (S) Read and write 15 (15%) 19 (19%) Primary school graduate 15 (15%) 20 (20%) Intermediate school graduate 22 (22%) 16 (16%) Preparatory school graduate 11 (11%) 13 (13%) Institute graduate 12 (12%) 7 (7%) College graduate 4 (4%) 4 (4%) Post-graduate 2 (2%) 2 (2%) Occupation before coronary artery bypass graft Employed 17 (17%) 16 (16%) C.C = 0.05 0.004 (HS) Unemployed 24 (24%) 24 (24%) Housewife 17 (17%) 19 (19%) Self-employed 27 (27%) 29 (29%) Retired 15 (15%) 12 (12%) After coronary artery bypass graft Returned to work 88 (88%) 88 (88%) 1(NS) Out of work 12 (12%) 12 (12%) Marital status Single 8 (8%) 11 (11%) C.C = 0.06 0.5 (NS) Married 87 (87%) 83 (83%) Widowed 3 (3%) 3 (3%) Divorced 2 (2%) 3 (3%) Residential area Urban 83 (83%) 87 (875) C.C = 0.05 0. 553 (NS) Rural 17 (17%) 13 (13%) Cigarette smoking Yes 18 (18%) 17 (17%) C.C = 0.01 0.5 (NS) No 82 (82%) 83 (83%) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article In the investigation of ischemic heart dis- eases in two groups, it was found that (44%) patients in the intervention group had a history of the disease and a history of ischemic heart diseases was observed in (22%) patients in the control group (P≤0.002). (36%) patients in the interven- tion group and (16%) had a history of kid- ney disease (P≤0.001). (38%) patients in the intervention group and (33%) patients in the control group had a history of other diseases (P≤0.031). 175 Table 2 shows that the clinical information of the patients was that (27%) patients in the intervention group and (30%) patients in the control group were overweight; the two groups did not have significant differ- ences in terms of BMI status. The duration of the disease in the patients showed that (61%) patients in the intervention group and (71%) patients in the control group had a disease duration of less than 5 years. (22%) Patients in the intervention group had disease duration between 5 and 9 years and the rest of the patients had disease duration of more than 10 years. (23%) Patients in the control group had disease duration between 5 and 9 years and the rest of the patients had dis- ease duration of more than 10 years, and the two groups had no significant differ- ence in terms of disease duration. There was a significant difference in the previ- ous hospital admission in the two groups (P ≤ 0.003). In the intervention group, (59%) patients had a history of one hospi- tal admission, and (23%) patients had a history of two hospital admissions. (13%) patients had a history of admission three times, and (5%) patient had a history of being admitted to the hospital more than three times. In the control group (66%) patients had a history of admission to the hospital once and (23%) patients had a history of being admitted to the hospital twice. (8%) patients had a history of ad- mission three times and (3%) patients had a history of admission to the hospital three times. The history of concomitant diseases in the two groups showed that (41%) patients in the intervention group had hypertension and (21%) patients in the control group had a history of hyper- tension (P≤0.005). The history of diabetes showed that (34%) patients in the inter- vention group had a history of diabetes and (18%) patients in the control group had a history of diabetes (P≤0.015). Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article sections general information, risk factor, complication, diagnosis and management of coronary artery bypass grafting among patients in the intervention group showed a significant increase compared to the baseline model (P≤0.001). The results showed that the mean overall awareness score in the intervention group at the be- ginning of the study is lower than the aver- age awareness score after the interven- tion, and this mean difference is significant (P≤0.001). The mean overall knowledge score in the intervention group has a sig- nificant difference compared to the control group. There were no significant differ- ences in the control group at different stages of the study (P > 0.050). Table 3 indicated that at the beginning of the study and before the start of the inter- vention, there was no significant differ- ence in the average knowledge score in the general information, risk factor, com- plication, diagnosis and management of coronary artery bypass grafting sections between the intervention and control group patients. After the intervention, the mean knowledge score in the general in- formation, risk factor, complication, diag- nosis and management of coronary artery bypass grafting sections showed a signifi- cant increase among patients in the inter- vention group compared to the control group (P≤0.001). The analysis of the re- sults within the group showed that the 176 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2: Distribution of the study group’s medical data (n= 200) Medical data Class Group P-Value* Intervention group (n=100) Control group (n=100) F (%) F (%) BMI Normal weight 73 (73) 70 (70) C.C = 0.05 P = 0.77 (NS) Overweight 27(27) 30 (30) Duration of the disease < 5 61 (61) 71 (71) C.C = 0.02 P = 0.65 (NS) 5 – 9 22 (22) 23 (23) > 10 17 (17) 6 (6) Previous admission to the hospital One time 59 (59) 66 (66) C.C = 0.1 0.003 (HS) Two times 23 (23) 23 (23) Three times 13 (13) 8 (8) More than three times 5 (5) 3 (3) Hypertension Yes 40 (40) 21 (21) C.C = 0.2 0.005 (HS) No 60 (60) 79 (79) Diabetes mellitus Yes 34 (34) 18 (18) C.C = 0.17 0.015 (S) No 66 (66) 82 (82) Ischemic heart disease Yes 44 (44) 22 (22) C.C = 0.22 0.001 (HS) No 56 (56) 78 (78) Kidney disease Yes 36 (36) 16 (16) C.C = 0.24 0.001 (HS) No 61 (61) 84 (84) Others Yes 38 (38) 33 (33) C.C = 0.16 0.031 (S) No 62 (62) 77 (77) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article it was shown that the mean duration of chest pain and CAD is less than 5 years, and according to the results of the present study, the duration of the disease is less than 5 years, so the results of these two studies are consistent. Based on the find- ings of this study, high blood pressure, dia- betes, ischemic heart disease, kidney dis- eases and other diseases were identified in the study subjects, and the patients of the intervention and control groups had sig- nificant differences in all co-morbidities. In the study conducted by Ejheisheh et al., [18] co-morbidities were identified as blood pressure, diabetes, dyslipidemia, The mean age of the patients in the con- trol group was 56.63±9.74 years and in the intervention group was 54.32±11.123 years. In the quasi-experimental study conducted by Z Noor et al., (2022) [16] in Kuala Lumpur, Malaysia, it was shown that the mean age group in the control group was 58.14 ± 11.78 and in the intervention group was 57.4 ± 12.3, which is higher than the mean age of the present study in both the control and intervention groups. Also, the two groups did not have a signifi- cant difference in mean age, which is con- sistent with this study. In a study conduct- ed in Saudi Arabia by M Hussain et al., [17] 177 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 3: Comparison of the mean score of knowledge of Coronary Artery Bypass Grafting between the two groups (n= 200) Variables Group Before the intervention After the intervention (t) value P-value* General information Intervention 121.20 ± 54.39 161.21 ± 65.57 40.1 0.001 Control 124.44 ± 26.14 126.22 ± 45.80 1.78 0.954 P 0.341 0.001 Risk factor Intervention 28.50 ± 43.25 38.60 ± 4.33 10.1 0.001 Control 29.50 ± 34.65 30.41 ± 32.62 0.91 0.821 P 0.514 0.001 Complication Intervention 25.05 ± 5.02 32.77 ± 47.21 7.72 0.001 Control 23.10 ± 57.69 21.22 ± 74.26 -1.88 0.914 P 0.784 0.001 Diagnosis Intervention 22.46 ± 7.24 29.80 ± 32.16 7.34 0.001 Control 24.31 ± 0.21 23.42 ± 66.31 -0.89 0.651 P 0741 0.001 management of Coronary Artery Bypass Grafting Intervention 15.32 ± 88.21 24.20 ± 32.14 8.88 0.001 Control 15.30 ± 33.83 16.20 ± 55.19 0.9 0.149 P 0.145 0.001 Knowledge Intervention 53 .33 ±17.32 94 .17 ±74.12 40.84 0.001 Control 54.32 ±47.36 55.14 ± 69.74 0.82 0.688 P 0.552 0.001 Discussion https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article of conducting educational programs in pa- tients similar to our study. Increasing awareness and information about the dis- ease is very vital and important for the pa- tient. In a study, the effect of training ses- sions to improve the knowledge of health care workers in early detection, diagnosis and management of RF and RHD in remote rural areas of western Nepal has been con- ducted. The results showed that holding training sessions and carrying out the in- tervention improved the knowledge score about risk factors and disease diagnosis which is consistent with the results of our study on the effect of intervention in in- creasing the awareness of patients of diag- nostic methods. By carrying out interven- tions and educational programs, aware- ness can be increased and earlier diagnosis of the disease will be better possible [22]. Coronary artery bypass surgery is one of the most effective treatment methods for cardiovascular diseases. Adherence to treatment and compliance with treatment orders after CABG is essential. The clinical trial study was conducted by Torknejad et al., [23] was shown that the scores of focus on treatment, willingness to participate in treatment, ability to adapt, combining treatment with life adherence to treat- ment, commitment to treatment and doubt in the implementation of treatment in the intervention group, after the inter- vention and 3 months after the interven- tion, had a significant increase compared to the control group. And finally, the mean of knowledge, attitude, behavioral inten- tion, subjective norms and enabling factors in the intervention group has increased significantly compared to the control group. Following treatment regimens and following behaviors related to health is called the healthy adherer effect. Its evalu- ation is very important in cardiovascular diseases. A cross-sectional study results, by Lee et al., [24] showed that carrying out and hypercholesterolemia. And among the patients of that study, unlike the pre- sent study, there was no difference in blood pressure and diabetes. The clinical trial study was conducted by Yuroong et al., [19] showed that educational inter- ventions before surgery, during surgery and after surgery were useful and effec- tive in improving and increasing the awareness of patients. The aforemen- tioned study and the implementation of the educational program are in line with the results of our study, which has led to an increase in the general awareness of patients about the disease. In our study, after the intervention, there was a signifi- cant difference between the intervention and control groups regarding the aware- ness of risk factors, and the intervention improved awareness in the intervention group. In case of coronary artery disease, a low level of health literacy and a lack of awareness of disease risk factors may have adverse consequences for patients. In a multicenter cohort study conducted by Brørs et al., [20] in Norway and Den- mark, after 6 months of follow-up, chang- es in the risk factors of physical activity, smoking, and psychological factors (HADS -T score, HADS-A score, and HADS-D score) have occurred, and these results are in line with the results of our study, indicating the positive effect of the educa- tional intervention. As a chronic and de- bilitating disease, heart diseases can re- sult in a high mortality rate, so they can have a significant impact on the lives of patients. In this regard, it is important and necessary to improve and promote the lives of patients and to be aware of the complications and problems of patients. Habibzadeh et al., [21] have shown that nutrition, physical activity, health respon- sibility, stress management, interpersonal relations and spiritual growth improved significantly and showed the importance 178 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article We are thankful to all patients who partici- pated in this study. The author declares no conflict of interest. [1] Benjamin, E.J, Virani, S.S, Callaway, C.W, Chamberlain, A.M, Chang, A.R, Cheng, A and et al. Heart Disease and Stroke Statistics- 2018 Update: A Report from the American Heart Association Circulation. 2018; 137(12): p. e67-e492. [2] Nowbar, A.N, Mauro Gitto, M, Howard, J.P, Francis, D.P and Al-Lamee, R. Mortality From Ischemic Heart Disease. Circulation, Cardio- vasc Qual Outcomes. 2019; 12(6): p. e005375. [3] Olvera Lopez, E, B.D. Ballard, and A. Jan, Cardiovascular Disease, in StatPearls. 2022, StatPearls Publishing, Copyright © 2022, StatPearls Publishing LLC.: Treasure Island (FL). [4] Ferrari, R, Camici, P.G, Crea, F, Danchin, N, Fox, K, Maggioni, A.P and et al. Expert con- sensus document: A 'diamond' approach to personalized treatment of angina. Nature Reviwe Cardiology. 2018; 15(2): p. 120-132. [5] Kreatsoulas, C, Shannon, H.S, Giacomini, M, Velianou, J.L and Anand, S.S. Reconstructing angina: cardiac symptoms are the same in women and men. JAMA Internal Medicine. 2013; 173(9): p. 829-31. [6] Alexander, J.H and P.K. Smith, Coronary- Artery Bypass Grafting. The New England Journal of Medicine. 2016; 375(10): p. e22. [7] Farkouh, M.E, Domanski, M, Sleeper, L.A, Siami, F.S, Dangas, G, Mack, M and et al. Strategies for multivessel revascularization in patients with diabetes. The New England Journal of Medicine. 2012; 367(25): p. 2375- 84. [8] Serruys, P.W, Morice, M.C, Kappetein, A.P, Colombo, A, Holmes, D.R, Mack, M.J and et al., Percutaneous coronary intervention ver- sus coronary-artery bypass grafting for se- vere coronary artery disease. The New Eng- land Journal of Medicine. 2009; 360(10): p. 961-72. educational programs and interventions could improve patients' adherence to treatment regimens and lifestyle modifica- tion, and salt consumption, low-fat diet and/or weight loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation of the studied patients were significantly im- proved in order to improve health. These results, in line with the results of our study, have already revealed the im- portance and role of interventions and ed- ucational programs. The results of this study showed that most of the patients were in the age group of over 50 years, most of the studied patients in both the intervention and control groups were male. And the samples of both groups were at a low level in terms of education, they were mostly married and urban dwellers. Most of the patients had normal weight, their disease duration was less than 5 years, most of the samples had high blood pressure, diabetes, ischemic disease and kidney disease, and the num- ber of smokers in both groups was low. The patients of the two groups had signifi- cant differences in demographic variables, disease course, educational background, type of employment before surgery, and previous hospitalization. Improvement in the level of knowledge of patients in the intervention group in general information, risk factors, complications, diagnosis and management of the disease has been es- tablished after the intervention. This study proved that the health education program had a positive effect on the coronary ar- tery bypass graft patient’s knowledge. 179 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. CONCLUSION ACKNOWLEDGEMENTS CONFLECT OF INETEST REFERENCES https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.16 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article [18] Ejheisheh, M, Correa-Rodríguez, M, Fernán- dez-Aparicio, A, Batran, A, Suleiman-Martos, N, Schmidt-RioValle. J.Prior percutaneous coronary intervention is associated with low health-related quality of life after coronary artery bypass graft. Nursing Health Sciences. 2020; 22(4): p. 1022-1029. [19] Yuroong, A, Asdornwised, U, Wanpen Pinyo- pasakul, W, Wongkornrat, W and Chansatit- porn, N .The Effectiveness of the Transitional Care Program Among People Awaiting Coro- nary Artery Bypass Graft Surgery: A Random- ized Control Trial. Journal of Nursing Scholar- ship. 2021; 53(5): p. 585-594. [20] Brørs, G, Dalen, H, Allore, H, Deaton, C, Frid- lund, B, Osborne, R.H and et al. Health Liter- acy and Risk Factors for Coronary Artery Disease (from the CONCARDPCI study). The American Journal of Cardiology. 2022; 179: p. 22-30. [21] Habibzadeh, H, Shariati, A, Mohammadi, F and Babayi, S. The effect of educational in- tervention based on Pender's health promo- tion model on quality of life and health pro- motion in patients with heart failure: an ex- perimental study. Bio Medical Central Cardi- ovascular Disorders. 2021; 21(1): p. 478. [22] Bhatt, N, Karki, A, Shrestha, B, Singh, A, Rawal, L.B and Sharma, S.K. Effectiveness of an educational intervention in improving healthcare workers’ knowledge of early recognition, diagnosis and management of rheumatic fever and rheumatic heart disease in rural far-western Nepal: a pre/post- intervention study. BMJ Open. 2022; 12(4): p. e059942. [23] Torknejad, A., S. Babaei and M. Mirmoham- madsadeghi, Effect of an educational inter- vention based on BASNEF model on treat- ment adherence after coronary artery by- pass surgery: A randomized clinical trial. ARYA atherosclerosis. 2020; 16(3): p. 105- 114. [24] Lee, Y-M, Kim, R.B, Lee, H.J, Kim, K, Shin, M- H, Park. H-K and et al. Relationships among medication adherence, lifestyle modifica- tion, and health-related quality of life in pa- tients with acute myocardial infarction: a cross-sectional study. Health and Quality of Life Outcomes. 2018; 16 (1): p. 100. [9] Hillis, L.D, Smith, P.K, Anderson, J.L, Bittl, J.A, Bridges, C.R, Byrne, J.G, Cigarroa, J.E and et al., 2011 ACCF/AHA Guideline for Coro- nary Artery Bypass Graft Surgery: a report of the American College of Cardiology Founda- tion/American Heart Association Task Force on Practice Guidelines Circulation. 2011; 124(23): p. e652-735. [10] Coyan, G.N, K.M. Reeder, and J.L. Vacek, Diet and Exercise Interventions Following Coronary Artery Bypass Graft Surgery: A Review and Call to Action. The Physician and Sportsmedicine. 2014; 42(2): p. 119-129. [11] Albert, N.M., S. Paul, and M. Murray, Com- plexities of Care for Patients and Families Living With Advanced Cardiovascular Diseas- es: Overview. The Journal of Cardiovascular Nursing. 2012; 27(2): p. 103-113. [12] Fredericks, S. and T. Yau, Educational inter- vention reduces complications and rehospi- talizations after heart surgery. Western jour- nal of nursing research. 2013; 35(10): p. 1251-1265. [13] Kalogianni, A, Almpani, P, Vastardis, L, Baltopoulos, G, Charitos, C, Brokalaki, H. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery? Euro- pean Journal of Cardiovascular Nursing. 2016; 15(6): p. 447-458. [14] Sharma, P, Yadav, L, Nepal, R , Khanal, S.B, Agrawal, S and Kattel, V. Coronary Artery Bypass Grafting among Patients Undergoing Cardiac Surgery in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. Journal of Nepal Medicine Assocation. 2022; 60 (246): p. 116-120. [15] Zia, K, Mangi, A.R, Minhaj, S, Tariq, K, Rabbi, F, \Musharafand,M and et al., An Overview of First 100 Cardiac Surgery Cases at a New- ly Developed Satellite Center in Sukkur, Pa- kistan, Cureus. 2020; 12(6): p. e8490. [16] Noor Hanita, Z, L. A. Khatijah, S. Kama- ruzzaman, C. Karuthan and R. A. Raja Mokh- tar. A pilot study on development and feasi- bility of the 'MyEducation: CABG applica- tion' for patients undergoing coronary ar- tery bypass graft (CABG) surgery. BioMed Central Nursing. 2022; 21(1): p. 40. [17] Hussain, M, Khan, N, Uddin, M and Al- Nozha, M.M. Duration analysis for coronary artery disease patients with chronic chest pain: an output from saudi arabia. Journal of cardiovascular and thoracic research. 2015; 7(1): p. 6-12. 180 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/