Health-related quality of life (HRQOL) is an important endpoint following cardiac surgery. Particularly in older age, HRQOL, rather than longevity, is the primary goal of treatment. However, prospective studies describing recovery and HRQOL are still scarce.
Aims:
To explore recovery patterns and HRQOL in patients undergoing cardiac surgery, emphasizing older patients ≥75 years of age.
Methods:
In a prospective population-based study, 534 patients (23% ≥75 years) were consecutively included before surgery. HRQOL, medical and socio-demographic variables were measured by questionnaires at baseline, 6 and 12 months after surgery. HRQOL was measured by the Short-Form Health Survey (SF-36).
Results:
Five hundred and twenty patients were alive 12 months after surgery, 89% responded after 6 and 12 months. Older patients as well as younger patients had a clear overall improvement in HRQOL over the first year after cardiac surgery, more specifically during the first 6 months. The same pattern was found in self-reported NYHA class which improved from baseline to 6 months and stabilized between 6 and 12 months. The only SF-36 scale with different development was Role Physical where younger patients improved more than older patients. Before surgery, patients had substantially lower scores than the population norms. However, on most dimensions of HRQOL older patients reached the level of the norm population after surgery.
Conclusion:
A selected group of elderly patients can undergo cardiac surgery with excellent results concerning survival and HRQOL. This is of major importance both discussing health care resources and decision making concerning individual patients.
HuberCHGoeberVBerdatPCarrelTEcksteinF. Benefits of cardiac surgery in octogenarians–a postoperative quality of life assessment. Eur J Cardiothorac Surg2007;31: 1099–105.
2.
JokinenJJHippelainenMJHanninenTTurpeinenAKHartikainenJE. Prospective assessment of quality of life of octogenarians after cardiac surgery: factors predicting long-term outcome. Interact Cardiovasc Thorac Surg2008;7: 813–8.
3.
AydinSYavuzTDuverHKutsalA. Quality of life in the elderly after coronary bypass surgery. Int Heart J2006;47: 59–65.
4.
LoponenPLutherMWistbackaJ-OKorpilahtiKLaurikkaJSintonenH. Quality of life during 18 months after coronary artery bypass grafting. Eur J Cardiothorac Surg2007;32: 77–82.
5.
NatarajanASamadianSClarkS. Coronary artery bypass surgery in elderly people. Postgrad Med J2007;83: 154–8.
6.
SilvayGCastilloJGChikweJFlynnBFilsoufiF. Cardiac anesthesia and surgery in geriatric patients. Semin Cardiothorac Vasc Anesth2008;12: 18–28.
7.
ChaturvediRKBlaiseMVerdonJIqbalSErginaPCecereR. Cardiac surgery in octogenarians: long-term survival, functional status, living arrangements, and leisure activities. Ann Thorac Surg2010;89: 805–10.
8.
NissinenJWistbackaJOLoponenPKorpilahtiKTeittinenKVirkkilaM. Coronary artery bypass surgery in octogenarians: long-term outcome can be better than expected. Ann Thorac Surg2010;89: 1119–24.
9.
ConawayDGHouseJBandtKHaydenLBorkonAMSpertusJA. The elderly: health status benefits and recovery of function one year after coronary artery bypass surgery. J Am Coll Cardiol2003;42: 1421–6.
10.
NashefSAMRoquesFMichelPGauducheauELemeshowSSalamonR. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg1999;16: 9–13.
11.
SjogrenJThulinLI. Quality of life in the very elderly after cardiac surgery: a comparison of SF-36 between long-term survivors and an age-matched population. Gerontology2004;50: 407–10.
12.
Levy PraschkerBGLeprincePBonnetNRamaABorsVLievreL. Cardiac surgery in nonagenarians: hospital mortality and long-term follow-up. Interact Cardiovasc Thorac Surg2006;5: 696–9.
13.
KurlanskyPAWilliamsDBTraadEAZuckerMEbraG. Eighteen-year follow-up demonstrates prolonged survival and enhanced quality of life for octogenarians after coronary artery bypass grafting. J Thorac Cardiovasc Surg2011;141: 394–9.
14.
SpezialeGNassoGBarattoniMCBonifaziREspositoGCoppolaR. Operative and middle-term results of cardiac surgery in nonagenarians: a bridge toward routine practice. Circulation2010;121: 208–13.
15.
GjeiloKHWahbaAKlepstadPLydersenSStensethR. Health-related quality of life three years after coronary surgery: a comparison with the general population. Scand Cardiovasc J2006;40: 29–36.
16.
KhanJHMagnettiSDavisEZhangJ. Late outcomes of open heart surgery in patients 70 years or older. Ann Thorac Surg2000;69: 165–70.
17.
JärvinenOSaarinenTJulkunenJHuhtalaHTarkkaMR. Changes in health-related quality of life and functional capacity following coronary artery bypass graft surgery. Eur J Cardiothorac Surg2003;24: 750–6.
18.
MarkouALPvan der WindtAvan SwietenHANoyezL. Changes in quality of life, physical activity, and symptomatic status one year after myocardial revascularization for stable angina. Eur J Cardiothorac Surg2008;34: 1009–15.
19.
NugterenLBSandauKE. Critical review of health-related quality of life studies of patients with aortic stenosis. J Cardiovasc Nurs2010;25: 25–39.
20.
RickhamPP. Human experimentation. Code of ethics of the world medical association. Declaration of Helsinki. Br Med J1964;2: 177.
21.
GjeiloKHWahbaAKlepstadPLydersenSStensethR. The role of sex in health-related quality of life after cardiac surgery: a prospective study. Eur J Cardiovasc Prev Rehabil2008;15: 448–52.
22.
WiedemannDBernhardDLauferGKocherA. The elderly patient and cardiac surgery–a mini-review. Gerontology2010;56: 241–9.
23.
LogeJHKaasaS. Short form 36 (SF-36) health survey: normative data from the general Norwegian population. Scand J Soc Med1998;26: 250–8.
24.
HollandRRechelBStepienKHarveyIBrooksbyI. Patients’ self-assessed functional status in heart failure by New York Heart Association class: a prognostic predictor of hospitalizations, quality of life and death. J Card Fail2010;16: 150–6.
25.
HerlitzJWiklundICaidahlKKarlsonBWSjolandHHartfordM. Determinants of an impaired quality of life five years after coronary artery bypass surgery. Heart1999;81: 342–6.
FalcozPEChocronSMercierMPuyraveauMEtieventJP. Comparison of the Nottingham Health Profile and the 36-item health survey questionnaires in cardiac surgery. Ann Thorac Surg2002;73: 1222–8.
28.
AgrestiA. Analysis of ordinal categorical data2 ed.New York: Wiley; 2010.
29.
HjermstadMJFayersPMBjordalKKaasaS. Using reference data on quality of life-the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+3). Eur J Cancer1998;34: 1381–9.
30.
FitzmauriceGMRavichandranC. A primer in longitudinal data analysis. Circulation2008;118: 2005–10.
31.
GjeiloKHKlepstadPWahbaALydersenSStensethR. Chronic pain after cardiac surgery: a prospective study. Acta Anaesthesiol Scand2010;54: 70–8.
32.
NaughtonCFeneckRORoxburghJ. Early and late predictors of mortality following on-pump coronary artery bypass graft surgery in the elderly as compared to a younger population. Eur J Cardiothorac Surg2009;36: 621–7.
33.
SedrakyanAVaccarinoVPaltielADElefteriadesJAMatteraJARoumanisSA. Age does not limit quality of life improvement in cardiac valve surgery. J Am Coll Cardiol2003;42: 1208–14.
34.
Statistics Norway. Age-specific death rates for males and females; 2010.
35.
TolmieEPLindsayGMKellyTTolsonDBaxterSBelcherPR. Are older patients’ cardiac rehabilitation needs being met?. J Clin Nurs2009;18: 1878–88.
36.
PasqualiSKAlexanderKPCoombsLPLytleBLPetersonED. Effect of cardiac rehabilitation on functional outcomes after coronary revascularization. Am Heart J2003;145: 445–51.
37.
MacchiCFattirolliFLovaRMContiAALuisiMLIntiniR. Early and late rehabilitation and physical training in elderly patients after cardiac surgery. Am J Phys Med Rehabil2007;86: 826–34.
38.
KummelMVahlbergTOjanlatvaAKarkiRMattilaTKivelaSL. Effects of an intervention on health behaviors of older coronary artery bypass (CAB) patients. Arch Gerontol Geriatr2008;46: 227–44.
39.
BarnasonSZimmermanLSchulzPTuC. Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden. Heart Lung2009;38: 459–68.
40.
WijnsWKolhPDanchinNDi MarioCFalkVFolliguetT. Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J2010;31: 2501–55.
41.
CalmanKC. Quality of life in cancer patients–an hypothesis. J Med Ethics1984;10: 124–7.
42.
FayersPMMachinD. Quality of life. Assessment, analysis and interpretation. 2 ed.Chichester: John Wiley & Sons LTD; 2007.
43.
WaltersSJMunroJFBrazierJE. Using the SF-36 with older adults: a cross-sectional community-based survey. Age Ageing2001;30: 337–43.
44.
SkiCFThompsonDR. Quality of life in cardiovascular disease: what is it and why and how should we measure it?. Eur J Cardiovasc Nurs2010;9: 201–2.
45.
BjessmoSSartipyU. Quality of life ten years after surgery for acute coronary syndrome or stable angina. Scand Cardiovasc J2010;44: 59–64.
46.
DunningJWallerJRLSmithBPittsSKendallSWHKhanK. Coronary artery bypass grafting is associated with excellent long-term survival and quality of life: a prospective cohort study. Ann Thorac Surg2008;85: 1988–93.
