Heart pillows (also known as cough pillows or cardiac pillows) are heart-shaped pillows often provided by hospitals to patients following sternotomy procedures.
Heart pillows have been used for decades and have become a tradition within cardiac care. The use of such pillows as a source of sternal support during coughing or sneezing has been integrated into post-surgical care procedures at many institutions; post-care guidelines advise the patients to begin use of the pillow following surgery and to continue its use during the entire recovery period.

Typical heart surgery pillow

Heart pillows may be purchased commercially through a promotional product company. In other cases, heart pillows are handmade by volunteers or family members. Pillows may bear “get well soon” messages from the hospital staff and may be accompanied by a marker for friends and hospital staff to sign during the post-surgical recovery period. Many patients treasure these pillows as mementos long after their scars have healed.

The broad integration into post-surgical care guidelines and medical claims made by some heart pillow manufacturers should lead one to expect that the use of the pillow as a form of sternal support has been evaluated. One promotional product distributer that sells heart pillows online claims that heart pillows provide “uniform, effective sternal support to aid in healing” and “pain reduction during coughing, deep breathing, and moving about”.1 If the heart pillow is a medical device that provides sternal support, aids healing, and reduces pain, the marketing claims should be supported by clinical evidence of safety and effectiveness.

"There seems to be little evidence to suggest that the pillow is effective when used as a therapeutic aid."

In this day of “evidence-based medicine” and a laser focus on reducing complications (thereby reducing costs to both the hospital and the patient), the heart pillow seems to have slipped through the cracks. Perhaps due to the tradition of use, or perhaps due to the likability and sentimentality of the heart pillow, it has maintained popularity in cardiac centers throughout the United States. (What’s not to love about a medical device you can hug?) Other than patient anecdotes on heart pillow websites, describing how much the patients like the heart pillow, there seems to be little evidence to suggest that the pillow is effective when used as a therapeutic aid.

In order to identify any existing evidence supporting the safe and effective use of heart pillows as a post- sternotomy recovery aid, we performed a PubMed search using the following keywords: “heart pillow”, “cough pillow”, “chest pillow”, “sternum splinting”, “sternum support”, “sternal support”, “self-hugging”, “postoperative sternum” and “postoperative sternal”. No publications examining the use of the heart pillow were identified using any of the search terms. A general on-line search for white papers or other information published on-line likewise did not identify any evidence supporting the safety or efficacy of heart pillow use in post-operative care. While the use of heart pillows in local post-surgical practice is common, there are likewise no accepted evidence-based guidelines for post-surgical care.

"Post-operative care must be examined and evidence-based best practice guidelines established."

Despite an improvement in surgical techniques, the rate of post-sternotomy complications has remained relatively stable for decades.2-5 This may, in part, be accounted for by research bias, as early research limited complication reporting to complications immediately post-surgery.6-7 More recently, the rates of complications during the recovery period following discharge have also been examined and represent a significant burden to patients’ quality of life and the healthcare system. At 90 days following sternotomy, deep sternal wound infections (DSWI) occur in 0.3% to 7.3% patients, 8-79% of patients experience ongoing pulmonary complications, and persistent pain affects 11-56% of patients. (Lack of established definitions and classification systems makes comparison of data among institutions difficult). The per-patient cost of DSWI treatment is $41,500-$88,800; pulmonary complication, $28,700; and persistent pain, $4500-$7700.8-12 If post-surgical complication rates and health care costs during the recovery period are to be reduced, post-operative care must be examined and evidence-based best practice guidelines established.

While there is a lack of published evidence supporting the use of the heart pillow in reduction of pain, it is generally accepted that hugging the pillow when coughing reduces pain, which may improve the quality of coughs and promote bronchial clearance. Additional factors need to be considered, however, when comparing the pillow to wearable devices, such as support harnesses or other external chest supports, which have been demonstrated to reduce patient-reported pain during coughing.13-14 The performance of the heart pillow in pain reduction and the effect of pillow use on other aspects of recovery need to be considered within an actual use environment.

Imagine, if you will, a simple study: post-surgical patients are asked to hold a pillow or apply an external chest support device. Patients are asked to cough and rate their pain. Both devices may perform well in reducing the perceived pain experienced during the cough. The pillow users may even experience a “bonus” reduction in pain because their device is cute!

"Does pillow use promote a user to be sedentary during the recovery period when compared to a wearable device?"

Now, let’s extend the study and send the pillow cohort and chest support cohorts home. Seated in front of the TV, both cohorts make use of their devices and experience pain-relief benefits. The pillow user, however, cannot make use of his pillow when performing self-care activities or other activities of daily living. What happens when a pillow patient feels a sneeze coming on? Does he reach across the couch for his pillow? Does he reach to the floor, where the pillow fell when he stood up? If the pillow is only effective when the user is holding the pillow, does pillow use promote a user to be sedentary during the recovery period when compared to a wearable device? How do the pillow retrieving motions affect the sternal gap? How do the devices compare in promotion of sternal stability? 

The external support user, who is wearing her device, has constant access to the pain relief mechanism as she goes about her activities of daily living. The wearable device moves with her to the bathroom; the pillow user must either go without the pillow, or perhaps bring the pillow along and place it on a contaminated sink surface. How do post-surgical infection rates compare for users of the two device types? May the constant pillow contact with environmental surfaces (in the home, car, and clinic) promote the transfer of bacteria to the surgical wound?

"The heart pillow must be relegated to the hospital gift shop and used as a memento, rather than as a medical device."

If post-surgical complication rates are to be reduced, it is necessary to examine all aspects of the post-care regimen and to develop established evidence-based guidelines for post-sternotomy care. Unless research supports the safe and effective use of the heart pillow as a therapeutic aid, the heart pillow must be relegated to the hospital gift shop and used as a memento, rather than as a medical device.

 

 References:

  1. Shumsky Therapeutic Pillows website. [c2015; cited 2017 Jan 26]. Available from: http://www.therapeuticpillows.com/heart-pillow/
  2. El 0akley RM, Wright JE. Postoperative Mediastinitis: Classification and Management. Ann Thorac Surg 1996;61:1030-6
  3. Rupprecht L, Schmid C. Deep Sternal Wound Complications: An Overview of Old and New Therapeutic Options. Open Journal of Cardiovascular Surgery 2013:6
  4. Singh K, Anderson E, Garrett Harper J. Overview and Management of Sternal Wound Infection. Semin Plast Surg 2011;25:25–33
  5. Losanoff JE, Richman BW, Jones JW. Disruption and infection of median sternotomy: a comprehensive review. European Journal of Cardio-thoracic Surgery 21 (2002) 831–839
  6. Jonkers D, Elenbaas T, Terporten P, Nieman F, Stobberingh E. Prevalence of 90-days postoperative wound infections after cardiac surgery. European Journal of Cardio-thoracic Surgery 23 (2003) 97–102
  7. Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg. 2001 Dec;20(6):1168-75
  8. Gaskin DJ and Richard P.  The Economic Costs of Pain in the United States. The Journal of Pain, Vol 13, No 8 (August), 2012: pp 715-724
  9. Shander a, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB. Clinical and economic burden of postoperative pulmonary complications: Patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med 2011 Vol. 39, No. 9
  10. Taylor GJ, Mikell FL, Moses HW, Dove JT, Katholi RE, Malik SA, Markwell SJ, Korsmeyer C, Schneider JA, Wellons HA. Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complications. Am J Cardiol. 1990 Feb 1;65(5):309-13.
  11. Graf K, Ott E, Vonberg RP, Kuehn C, Haverich A, Chaberny IF. Economic aspects of deep sternal wound infections. European Journal of Cardio-thoracic Surgery 37 (2010) 893—896
  12. Brown PP, Kugelmass AD, Cohen DJ, Reynolds MR, Culler SD, Dee AD, Simon AW. The Frequency and Cost of Complications Associated With Coronary Artery Bypass Grafting Surgery: Results from the United States Medicare Program. Ann Thorac Surg 2008;85:1980–7
  13. Meisler P. The sternum support harness for the treatment of sternotomy pain and the prevention of sternal instability. Cardiopulmonary Phys Ther J 2003;Dec
  14. El-Ansary D, Waddington G, Adams R. Control of Separation in Sternal Instability by Supportive Devices: A Comparison of an Adjustable Fastening Brace, Compression Garment, and Sports Tape. Arch Phys Med Rehabil 2008;89:1775-81

Comments

Al Seck on

Great post! “Cuteness” does not equal prevention!! Post sternotomy patients deserve the best designed, proven medical products.

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