Time related quality of life after elective cardiac operation

doi:10.1016/S0003-4975(99)00675-X

The Annals of Thoracic Surgery

Volume 68, Issue 4, October 1999, Pages 1314-1320

https://doi.org/10.1016/S0003-4975(99)00675-X Get rights and content

Abstract

Background. Due to improved operative techniques, myocardial preservation, and perioperative care, open heart procedures are now being performed in older and sicker patients. As a result, the quality of life has become an important issue in the decision making process.

Methods. Between January 1993 and October 1994, 604 patients above 65 years of age who underwent non-emergent open heart operations were followed prospectively over a 2-year period. The Health Status Questionnaire forms were distributed to all patients preoperatively and to hospital survivors at 3, 12, and 24 months. The questionnaire contains 36 questions and is divided into eight categories. Follow-up was 100% complete with 99.6% of questionnaires returned.

Results. Significant quality of life improvements were noted in all categories after surgery. After reaching a peak at 12 months, there were small, but significant declines in scores relating to physical health and health perception at 24 months. In contrast, measurements for mental attributes continued to increase with time. By multivariate analysis, diabetes, older age, and female gender had a relatively adverse influence on quality of life despite improvement after operation. Similarly, patients with chronic obstructive pulmonary disease or having redo operations had lower health perception with some physical limitations. While procedure type (coronary artery bypass grafting) was associated with preoperative bodily pain, congestive heart failure symptoms were not an independent factor affecting quality of life.

Conclusions. Quality of life improves with cardiac surgical interventions in this studied age group and should not be denied even in the elderly population.

Section snippets

Patients and methods

From January 1993 to October 1994, 850 patients above 65 years of age underwent cardiac surgery requiring cardiopulmonary bypass in the Department of Cardiac Surgery at the Kaiser Permanente Medical Center (Los Angeles, CA). This represented 40% of the 2,113 adult open heart operations (mean age 62.8 years) performed during this period. To focus the analysis on commonly performed procedures, only individuals requiring coronary artery bypass grafting (CABG), valve procedure, or a combination

Results

The overall 30-day hospital mortality rate was 3.3% ± 0.7% (2.7% ± 0.8% for CABG ± miscellaneous, 4.2% ± 2% for valve surgery ± miscellaneous, and 5.9% ± 2.9% CABG + valve surgery, p = NS). There were 41 late deaths during the 2-year follow-up period (28 for CABG ± miscellaneous, 10 for valve surgery ± miscellaneous, and 3 for CABG + valve surgery, p = NS). Therefore, 543 patients survived to complete the study and their quality of life data were entered into the analysis.

Selective preoperative

Comment

While mortality and morbidity rates, symptoms of illness, and return to normal activity are commonly used objective measures of clinical outcome after cardiac surgery, these represent only part of what clinicians typically regard as recovery. Recent emphasis has been placed on changes in functional status and feelings of well-being postoperatively. Most studies of this kind have concentrated on patients undergoing CABG 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 with few reports 18, 19, 20

Acknowledgements

Supported in part by the Garfield Foundation.

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Caregiver burden and outcomes of caregiving of spouses of patients who undergo coronary artery bypass graft surgery
2007, Heart and Lung: Journal of Acute and Critical Care
Citation Excerpt :
Because of traditional gender roles, some of the care these patients may need after surgery, such as monitoring sternal or leg incisions or assistance with bathing or getting out of bed, may not be skills that male caregivers had before the surgical event. In addition, as documented in multiple studies,41-48 male caregivers also need to be informed that the recovery of female patients is often different because of their advanced age, multiple comorbidities, and generally more advanced heart disease at the time of CABG surgery. By learning what to expect, spouses can be given assistance with skills they need to learn and on how and when to ask for caregiving assistance from their support networks.
Patients who undergo coronary artery bypass graft surgery often rely on spouses for care during recovery. Although often meaningful, caregiving may be stressful and affect spouses’ ability to provide care to the patient.
The purpose of this study was to compare burden and caregiving outcomes across three groups of spouses. Spouse groups varied by the interval of time between surgery and follow-up, which may have been 3, 6, or 12 months.
This cross-sectional comparative study recruited a convenience sample of 166 spouses on the basis of a power analysis. A total of 166 spouses completed caregiver surveys on burden and other caregiving outcomes.
Total, objective, and subjective burden levels were low to moderate. Although no burden differences were found between groups, men had higher total burden but more positive caregiving outcomes. Future outlook and social activities were less positive in the 6-month group. Burden levels were not lower, nor were caregiving outcomes higher, in the 12-month group, suggesting a steady caregiving demand across the first year after coronary artery bypass graft surgery.
Longitudinal investigations are needed to understand burden and caregiving outcomes over time and the impact of burden on spousal and patient recovery outcomes.
Functional status of patients during subacute recovery from coronary artery bypass surgery
2007, Heart and Lung: Journal of Acute and Critical Care
Patients recovering from coronary artery bypass (CAB) surgery are particularly vulnerable to impaired functional status because in addition to the direct effects of heart disease on cardiac performance, many surgical factors may contribute to loss of function.
The purposes of this study were to describe functional status across multiple domains using performance-based and self-report assessments and to determine the relationship among different domains of functional status in patients recovering subacutely (<6 months) from CAB surgery.
The participants in this study (n = 25) had undergone CAB surgery in the past 6 months. This cross-sectional descriptive study measured functional status in several domains using self-report and performance-based assessments.
The study results indicate that participants had deficits in health-related quality of life, activities of daily living performance, endurance/aerobic capacity, and cognitive/memory ability. Several correlations between the scores for outcome measures in different domains were found in this study.
Impaired functional status occurs in patients recovering subacutely from CAB surgery. Different aspects of functional status are related, and an understanding of these relationships may help to improve the medical management of patients after CAB surgery.
The synergistic effect of heart disease and diabetes on self-management, symptoms, and health status
2006, Heart and Lung: Journal of Acute and Critical Care
Coronary heart disease (CHD) and diabetes may have synergistic effects on symptoms, self-management, and general and cardiac-specific health status.
We compared symptom distress, self-management difficulties, and general and cardiac-specific health status in patients with CHD by the presence and severity of diabetes.
We performed a cross-sectional study of 1013 patients enrolled in the COURAGE trial, with the use of clinical data, the Symptom Distress Scale, the Self-Management Difficulties Scale, the Short-Form 36, and the Seattle Angina Questionnaire.
Patients with diabetes and greater severity of diabetes had worse findings in symptom distress, self-management difficulties, and general and cardiac-specific health status than patients without diabetes.
A robust effect of diabetes on symptom distress and self-management difficulties was found in patients with CHD. The results from the Seattle Angina Questionnaire illustrate difficulty in attributing physical limitations to specific symptoms or conditions, and show the experience of comorbid conditions to be synergistic. Clinicians’ understanding of this synergy and integration of condition-specific care with general treatment and self-management practices are needed.
Quality of life outcomes after coronary artery bypass graft surgery: Relationship to neuropsychologic deficit
2005, Journal of Thoracic and Cardiovascular Surgery
Neuropsychologic assessment after coronary artery bypass graft surgery indicates cognitive deficits, but data on their effect on health-related quality of life are relatively sparse. The present study assessed neuropsychologic deficits, self-reported health-related quality of life, and mood, together with proxy rating of patients’ activities after bypass surgery. More specifically, the study examines the relationship between these varied outcome measures.
A prospective longitudinal assessment of 71 male patients was performed over a 6-month period: 1 week before surgery and postoperatively at 2 and 6 months. Within-patient change was assessed with the neuropsychologic test battery and procedures recommended by the Consensus Panel, the Short Form-36 to measure self-reported health-related quality of life, and the Hospital Anxiety and Depression Scale questionnaire to assess anxiety and depression. Proxy ratings were documented with the Functional Activities Questionnaire.
Poor preoperative health-related quality of life was largely unrelated to medical variables. Cognitive deficit was found in 42% of patients at 2 months and 22% of patients at 6 months. Physical health-related quality of life improved, but benefit for emotional and social functioning was unconvincing, especially over the short term. Although cognitive deficits were largely unrelated to Short Form-36 health-related quality of life, and only partially related to anxiety and depression, they were associated with proxy ratings of patient functioning.
Physical health-related quality of life benefits were confirmed, but adverse cognitive change and only limited emotional benefit were evident after coronary artery bypass graft surgery. Perceived physical gains are unrelated to any cognitive deficit, but the latter correlated with the emotional status of the patient 6 months after surgery and are of concern to close relatives. These issues should be addressed in patient care.
Patients with type 2 diabetes undergoing coronary artery bypass graft surgery: Predictors of outcomes
2009, European Journal of Cardiovascular Nursing
Quality of life during 18 months after coronary artery bypass grafting
2007, European Journal of Cardio-thoracic Surgery

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Original Articles: CardiovascularTime related quality of life after elective cardiac operation

Abstract

Section snippets

Patients and methods

Results

Comment

Acknowledgements

J Thorac Cardiovasc Surg

Am J Cardiol

Chest

Ann Thorac Surg

Chest

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Medicine and quality of life

Ann Intern Med

Interpretation and scoring the SF-36 Health Survey

Preliminary tests of a 6-item general health surveya patient application

Original Articles: Cardiovascular
Time related quality of life after elective cardiac operation