Vol. 53 | No. 1 | January-June 2025 Back

Open Access

Clinical Profile and Outcome of Patients who Underwent Coronary Artery Bypass Graft Surgery Under Philhealth Z Benefit Package in Manila Doctors Hospital

Bienvenido P. Tiu Jr., Felix Eduardo R. Punzalan, Noemi S. Pestaño, Chermaine Love C. Cañaveral, Maria Grethel C. Dimalala-Lardizabal, Rogelio V. Tangco, Dante D. Morales, Nelson S. Abelardo, Eugenio B. Reyes
May 2025 DOI 10.69944/pjc.5a4eb10e7b

Abstract

Objective: This study aims to determine the clinical profile and incidence of in-hospital outcomes of patients who underwent coronary artery bypass graft surgery (CABG) under the Philippine Health Insurance Corporation (Philhealth) Z Benefit Package (PZBP).

Methods: A retrospective descriptive cohort study. A review of medical records was done from July 2017 to October 2023 to collect data and in-hospital outcomes of patients who underwent CABG surgery under Z benefit package.

Results: One hundred twenty-six patients were included in the study. The mean age of patients was 60 years and majority of them were male and came from NCR. Hypertension was the leading cause of comorbidity. The top two most common in-hospital outcomes were hospital-acquired pneumonia and postoperative atrial fibrillation. Most commonly observed caused of increased length in hospitalization was pneumonia. The mean Society of Thoracic Surgeons (STS) (operative mortality) and Euro scores were 1.04 ± 0.82 and 0.88 ± 0.56, respectively. All patients had successful surgical outcome with no mortality and an average length of stay in the hospital of six days.

Conclusions: This study will serve as a future reference to enhance screening criteria and improved in-hospital outcomes for those who will undergo CABG under Z benefit package. The study also showed insights on clinical profile and in-hospital outcomes of patients who underwent CABG in our own institution and this may give way to a larger scale of study involving multiple centers who also offer the said program.

References
  1. Khan MA, Hashim MJ, Mustafa H, Baniyas MY, Al Suwaidi SKBM, AlKatheeri R, et al. Global epidemiology of ischemic heart disease: Results from the global burden of disease study. Cureus [Internet]. 2020;12(7):e9349. Available from: http://dx.doi.org/10.7759/cureus.9349
  2. Wang F, Yu Y, Mubarik S, Zhang Y, Liu X, Cheng Y, et al. Global burden of ischemic heart disease and attributable risk factors, 1990-2017: A secondary analysis based on the Global Burden of Disease Study 2017. Clin Epidemiol [Internet]. 2021;13:859–70. Available from: http://dx.doi.org/10.2147/CLEP.S317787 
  3. Cardiovascular diseases (CVDs) [Internet]. Who.int. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
  4. Global burden of metabolic risk factors for chronic diseases collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol [Internet]. 2014;2(8):634–47. Available from: http://dx.doi.org/10.1016/S2213-8587(14)70102-0
  5. Kabagani LJ. Heart disease remains top cause of death in PH in 2021: PSA [Internet]. Philippine News Agency. 2022. Available from: https://www.pna.gov.ph/articles/1168439 
  6. Balita C. Number of deaths from ischemic heart disease Philippines 2021, by gender [Internet]. Statista. 2024. Available from: https://www.statista.com/statistics/1120365/philippines-number-of-deaths-caused-from-heart-disease-by-gender/
  7. Eagle KA, Guyton RA, Davidoff R, Ewy GA, Fonger J, Gardner TJ, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: executive summary and recommendations : A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1991 guidelines for coronary artery bypass graft surgery): A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the 1991 guidelines for coronary artery bypass graft surgery). Circulation [Internet]. 1999;100(13):1464–80. Available from: http://dx.doi.org/10.1161/01.cir.100.13.1464
  8. Galicio RP, Vicente F. Outcome of patients who underwent coronary artery bypass graft with concomitant valve surgery in Philippine heart center. Phil Heart Center J [Internet]. 2007 [cited 2025];13(2):119–23. Available from: https://online.phc.gov.ph/about-phc/journals/pdf/galicio.pdf
  9. Philippine Health Insurance Corporation. PhilHealth Circular No. 0002, s.2013: Z Benefit Package Rates for Coronary Artery Bypass Graft Surgery, Surgery for Tetralogy of Fallot, Surgery for Ventricular Septal Defect and Cervical Cancer [Internet]. 2013 [cited 2025]. Available from: https://www.philhealth.gov.ph/circulars/2013/circ02_2013.pdf
  10. Dela Cruz AV, Bayani DDC II, Gonzales EM, Tiongson MDA, Tomas AB, Chua EM II, et al. View of timelines of philhealth Z benefit package for standard risk coronary artery bypass graft (CABG) surgery at the university of the Philippines- Philippine general hospital. Acta Medica Philip [Internet]. 2021 [cited 2025];55(1):41–6. Available from: https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/2953/2032
  11. Dimalala MG. Clinical profile and in-hospital outcomes of patients under Philhealth CABG Z Benefit package in a tertiary hospital. Unpublished manuscript, Manila Doctors Hospital. 2017.
  12. Sianos G, Morel M-A, Kappetein AP, Morice M-C, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1(2):219–27.
  13. Makris K, Spanou L. Acute kidney injury: Definition, pathophysiology and clinical phenotypes. Clin Biochem Rev. 2016;37(2):85–98.
  14. Nakamaru R, Shiraishi Y, Sandhu AT, Heidenreich PA, Shoji S, Kohno T, et al. Cardiovascular vs. non-cardiovascular deaths after heart failure hospitalization in young, older, and very old patients. ESC Heart Fail [Internet]. 2023;10(1):673–84. Available from: http://dx.doi.org/10.1002/ehf2.14245 
  15. Hemmann K, Sirotina M, De Rosa S, Ehrlich JR, Fox H, Weber J, et al. The STS score is the strongest predictor of long-term survival following transcatheter aortic valve implantation, whereas access route (transapical versus transfemoral) has no predictive value beyond the periprocedural phase. Interact Cardiovasc Thorac Surg [Internet]. 2013;17(2):359–64. Available from: http://dx.doi.org/10.1093/icvts/ivt132
  16. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium: A consensus report from the bleeding academic research consortium. Circulation [Internet]. 2011;123(23):2736–47. Available from: http://dx.doi.org/10.1161/CIRCULATIONAHA.110.009449
  17. Authors/Task Force members, Windecker S, Kolh P, Alfonso F, Collet J-P, Cremer J, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: The task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI): The task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J [Internet]. 2014;35(37):2541–619. Available from: http://dx.doi.org/10.1093/eurheartj/ehu278
  18. Brown JC, Gerhardt TE, Kwon E. Risk factors for coronary artery disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554410/
  19. Jiang C, Chen Q, Xie M. Smoking increases the risk of infectious diseases: A narrative review. Tob Induc Dis [Internet]. 2020;18(July):60. Available from: http://dx.doi.org/10.18332/tid/123845
  20. Raymundo E, Ramos L, Morales D. Clinical Profiles and Outcomes of Patients Who Underwent Coronary Artery Bypass Graft Procedures at Manila Doctors Hospital from May 1, 2009 to December 31, 2015. Unpublished manuscript.
  21. Canto JG, Kiefe CI, Rogers WJ, Peterson ED, Frederick PD, French WJ, et al. Number of coronary heart disease risk factors and mortality in patients with first myocardial infarction. JAMA [Internet]. 2011;306(19):2120–7. Available from: http://dx.doi.org/10.1001/jama.2011.1654
  22. Nicolau JC, Stevens SR, Al-Khalidi HR, Jatene FB, Furtado RHM, Dallan LAO, et al. Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial. Int J Cardiol [Internet]. 2019;291:36–41. Available from: http://dx.doi.org/10.1016/j.ijcard.2019.03.029
  23. Awan NI, Jan A, Rehman MU, Ayaz N. The effect of ejection fraction on mortality in Coronary Artery Bypass Grafting (CABG) patients. Pak J Med Sci Q [Internet]. 2020;36(7):1454–9. Available from: http://dx.doi.org/10.12669/pjms.36.7.3266
  24. Wang D, Huang X, Wang H, Le S, Yang H, Wang F, et al. Risk factors for postoperative pneumonia after cardiac surgery: a prediction model. J Thorac Dis [Internet]. 2021;13(4):2351–62. Available from: http://dx.doi.org/10.21037/jtd-20-3586
  25. Zaman AG, Archbold RA, Helft G, Paul EA, Curzen NP, Mills PG. Atrial fibrillation after coronary artery bypass surgery: a model for preoperative risk stratification: A model for preoperative risk stratification. Circulation [Internet]. 2000;101(12):1403–8. Available from: http://dx.doi.org/10.1161/01.cir.101.12.1403
  26. Peretto G, Durante A, Limite LR, Cianflone D. Postoperative arrhythmias after cardiac surgery: incidence, risk factors, and therapeutic management. Cardiol Res Pract [Internet]. 2014;2014:615987. Available from: http://dx.doi.org/10.1155/2014/615987
  27. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines: A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation [Internet]. 2011;124(23):2610–42. Available from: http://dx.doi.org/10.1161/CIR.0b013e31823b5fee 
License

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.