Determinants for an impaired quality of life 10 years after coronary artery bypass surgery

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Abstract

Objective: To identify determinants of an inferior quality of life (QoL) 10 years after coronary artery bypass grafting (CABG). Setting: Sahlgrenska University Hospital, Göteborg, Sweden. Participants: All patients from Western Sweden who underwent CABG between 1988 and 1991 without simultaneous valve surgery and no previous CABG. Main outcome measures: Questionnaires for evaluating QoL 10 years after the operation. Three different instruments were used: The Nottingham health profile (NHP), the psychological general wellbeing index (PGWI), and the Physical Activity Score (PAS). Results: 2000 patients underwent CABG, of whom 633 died during 10 years of follow-up. Information on QoL at 10 years was available in 976 patients (71% of survivors). A history of diabetes and chronic obstructive pulmonary disease were the two independent predictors for an inferior QoL with all three instruments. Furthermore, there were three predictors of an inferior QoL with two of the instruments: high age, female sex and a history of hypertension. A number of factors predicted an inferior QoL with one of the instruments. These were the duration of angina pectoris and functional class prior to CABG, renal dysfunction, a history of cerebrovascular disease, obesity, height, duration of respirator treatment and requirement of inotropic drugs postoperatively. In addition, when introducing preoperative QoL into the model a low QoL before surgery was a strong independent predictor also of an inferior QoL 10 years after CABG. Conclusion: Variables independently predictive of an impaired QoL 10 years after CABG, irrespective of the instrument used, were an impaired QoL prior to surgery, chronic obstructive pulmonary disease and a history of diabetes. However, other factors reflecting gender, the previous history as well as postoperative complications were also associated with the QoL 10 years later in at least one of these instruments.

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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