Prospective study of quality of life before and after open heart operations

doi:10.1016/0003-4975(95)00936-1

The Annals of Thoracic Surgery

Volume 61, Issue 1, January 1996, Pages 153-157

https://doi.org/10.1016/0003-4975(95)00936-1 Get rights and content

Background.

The aim of this prospective study, with completion of questionnaires before and 3 months after open heart operations, was to evaluate the improvement of quality of life brought about by these operations and the predictors of this improvement.

Methods.

The Nottingham health profile questionnaire contains 38 subjective statements dividend into six sections: energy, physical mobility, emotional reaction, pain, sleep, and social isolation. Factors influencing quality of life scores were determined by analysis of covariance. Factors influencing the status of the patients (improved or worsened) were determined by logistic regression.

Results.

From January to July 1994, 215 consecutive patients underwent elective open heart operations. The comparison between mean preoperative and postoperative scores showed an improvement in all sections of quality of life. An average of 80% of patients were improved by their operations. Independent predictors of less improvement of quality of life scores were as follows: for the energy section, age over 70 and New York Heart Association functional class III or IV; for sleep, age over 70; for physical mobility, New York Heart Association functional class III or IV; for social isolation, female gender; and for pain, age over 70 and abnormal segmental wall motion. Independent predictors of patients worsened by operation were as follows: New York Heart Association functional class III or IV in the energy section (odds ratio = 3.7, 95% confidence interval 1.4 to 9.8) and in the physical mobility section (odds ratio = 2.4, 95% confidence interval 1.02 to 5.5), female gender in the social isolation section (odds ratio = 2.8, 95% confidence interval 1.03 to 7.7), and presence of at least one comorbid disease in the emotional reaction section (odds ratio = 2.5, 95% confidence interval 1.17 to 5.2).

Conclusions.

Cardiac operations improve quality of life in patients. The improvement is similar for patients undergoing coronary artery bypass grafting versus valve replacement, and for patients with no postoperative events versus those with nonlethal postoperative complications. The strongest predictive factors for quality of life are age and New York Heart Association functional class.

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Health-related quality of life (HRQoL) of patients, aged 75 years or older, was measured before and at 12 weeks after cardiac surgery using a generic tool (SF12 version 2).
This was a single centre, prospective study of patients aged 75 years or older who had any type of cardiac surgery. The instrument was self-administered preoperatively and by interviewer administered via telephone at 12 weeks.
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Health-related quality of life (HRQOL) is an increasingly important issue in assessing the consequences of any surgical or medical intervention. Our study aimed to evaluate change in HRQOL 6 months after elective cardiac operations and to identify specific predictors of poor HRQOL.
In this prospective, single-center study, HRQOL was evaluated before and 6 months after the operation using the Medical Outcome Study 36-Item Short Form Health Survey questionnaire and its two components: the Physical Component Summary and the Mental Component Summary. We distinguished patients with worsening of HRQOL according to the minimal clinically important difference. All consecutive adult patients undergoing cardiac operations were included.
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To examine whether preoperative biomedical risk and depressive symptoms were associated with physical and mental components of health-related quality of life (HRQoL) in patients 1 year after cardiac surgery.
Seventy-five patients completed a psychological evaluation, including the Center for Epidemiological Study of Depression scale, the 12-item Short-Form Physical Component Scale (SF-12-PCS) and Mental Component Scale (SF-12-MCS), the Instrumental Activities of Daily Living questionnaire for depressive symptoms and HRQoL, respectively, before surgery and at 1-year follow-up.
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The current findings showed that preoperative depressive symptoms are associated with poor physical and mental components of HRQoL, whereas high biomedical risk predicts reduced physical, but not mental, functioning in patients postoperatively. This study suggests that a preoperative assessment of depressive symptoms in addition to the evaluation of common biomedical risk factors is essential to anticipate which patients are likely to show poor HRQoL after cardiac surgery.
Relationship between quality of life and aerobic capacity of patients entering phase II cardiac rehabilitation after coronary artery bypass graft surgery
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Citation Excerpt :
The goal of coronary bypass surgery is to eliminate or reduce symptoms associated with CAD, such as angina and breathlessness, improve the patients' quality of life (QOL), and reduce the risk of further myocardial infarctions.3 Coronary bypass surgery can reduce mortality and the symptoms of chest pain as well as enhance exercise tolerance and daily life activities.4 The clinical assessment of outcomes after CABG is based on the objective evaluation of the patient's cardiovascular status and physical performance.
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One hundred and two patients were administered a version of the World Health Organization Quality of Life brief form questionnaire (WHOQOL-BREF). Then, each patient underwent cardiopulmonary exercise tests to determine their aerobic fitness and %FAI. We performed Pearson's and Spearman's correlation analyses to assess the association between variables on the WHOQOL-BREF questionnaire and the each patient's aerobic fitness.
Pearson's correlation coefficient demonstrated a significant association between WHOQOL-BREF scores and peak oxygen uptake (peak VO₂) in the physical domain (p = 0.006) and environment domain (p = 0.011). Spearman's correlation coefficient also demonstrated a significant association between WHOQOL-BREF scores and the %FAI in the environmental domain (p = 0.036).
QOL of patients who have undergone coronary artery bypass graft surgery is influenced not only by impaired aerobic fitness but also by poor physical and psychological well-being. The implementation of proper lifestyle modifications and the strengthening of social support networks following CABG surgery are very important for maximizing cardiovascular fitness and improving the QOL of these patients.
Improvements in health-related quality of life before and after isolated cardiac operations
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Our study compared health-related quality of life (HRQOL) among cardiac surgical patient groups before and after cardiac operations for isolated surgical procedures and examined cardiac surgical patient HRQOL within the context of United States population norms.
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Overall, the 370 cardiac surgical patients were 61.5 ± 11.9 years old, 70% men, and 76% white. Significant baseline differences in HRQOL existed among the cardiac surgical groups. Physical and mental components of the Short Form 36 improved from baseline to within 3 to 6 months postoperatively and remained stable through 3 years for all groups. When demographic and clinical covariates were held constant, the effect of cardiac surgical type on postsurgical HRQOL changes was not significant.
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Patients' and significant others' health-related quality of life one month after coronary artery bypass grafting predicts later health-related quality of life
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To describe and compare the health-related quality of life (HRQoL) of patients (N = 367) and significant others (N = 367) and to identify factors associated with HRQoL after coronary artery bypass grafting (CABG).
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Patients had a lower HRQoL than significant others in both stages after CABG. The HRQoL of patients and significant others was explained by their HRQoL 1 month after the operation. Other significant explanatory factors among patients were cardiac symptoms on physical exertion and other additional diseases. Among significant others, chronic diseases were associated with HRQoL.
The HRQoL of patients and significant others differed from each other at both 6 and 12 months after CABG. Previous HRQoL affects later HRQoL in both patients and significant others.

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Original article: CardiovascularProspective study of quality of life before and after open heart operations

Background.

Methods.

Results.

Conclusions.

Am J Cardiol

Soc Sci Med

Prospective study of quality of life before and after coronary artery bypass grafting

BMJ

Quality of life six months after coronary artery bypass surgery: a preliminary report

South Med J

Measuring health status: a new tool for clinicians and epidemiologists

J R Coll Gen Pract

Original article: Cardiovascular
Prospective study of quality of life before and after open heart operations