Determinants for an impaired quality of life 10 years after coronary artery bypass surgery
Introduction
An increasing number of patients undergo coronary artery bypass grafting (CABG) in order to improve survival [1] and relieve symptoms [2], [3].
However, during long-term follow-up the risk of symptom recurrence is substantial [4], which might adversely influence the outcome and patients' QoL. Although a large number of surveys have explored the QoL during the first few years after CABG [5], [6] the experiences of QoL during long time after CABG are limited. This is particularly important since patients undergoing CABG have a high long-term survival rate. This study aims at describing factors associated with an impaired QoL 10 years after the operation. We have previously described factors associated with an impaired QoL 5 years after the operation [7].
Section snippets
Patient population
Between June 1988 and June 1991 all patients from western Sweden who underwent CABG at the department of Thoracic and Cardiovascular Surgery at Sahlgrenska University Hospital and at the Scandinavian Heart Centre in Göteborg were registered prospectively. These two hospitals performed all the CABGs in the western health care region of Sweden with a population of about 1,600,000 at the time. All patients were followed for at least 10 years after CABG, except for 11 patients who emigrated during
Statistical methods
To identify independent risk factors of an impaired QoL (defined as a total score above the median for NHP, below the median for PGWB, and above the median for Physical Activity) at 10 years after operation we applied the following strategy for each of the instruments. First, we univariately tested variables for association with an impaired QoL, using chi-square and Mann–Whitney U tests. The variables tested were preoperative factors (i.e. all variables in Table 1 and also angina duration, a
Results
In all, 2365 patients underwent CABG during the time of the survey. Of them 231 were excluded due to simultaneous valve surgery, 121 due to previous CABG and 13 due to both. Of the remaining 2000 patients 633 (32%) died during the 10 years of follow-up. Of the survivors at 10 years 976 responded to the inquiry (71%) at that stage. Of all 2000 patients 1225 (61%) responded to the inquiry prior to surgery and 637 both prior to and 10 years after surgery (47% of survivors).
The median interval
Discussion
One of the major goals when offering patients with coronary artery disease bypass surgery is to reduce symptoms and thereby improve QoL. However, experiences indicate that a substantial part of the patients have recurrence of symptoms over time [4], [5], [21]. Therefore, in a long-term perspective, many patients still have an impaired QoL [6], [7]. No one has, as far as we know, tried to define factors associated with an impaired QoL among patients who survive for a very long time after cardiac
Conclusion
Variables independently predictive of an impaired QoL 10 years after CABG irrespective of the instrument used were an impaired QoL prior to surgery and chronic obstructive pulmonary disease and a history of diabetes. However, other factors reflecting gender, previous history as well as postoperative complications were also associated with the QoL 10 years later in at least one of these instruments.
Uncited reference
[23]
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