Time to expand risk evaluation systems for cardiac surgery? Looking beyond physiological parameters

Abstract

Risk assessment in cardiac surgery traditionally consists of medical and physiological parameters. However, non-physiological factors have also been found to be predictive of poor outcomes following cardiac surgery. Therefore, the isolated focus on physiological parameters is questionable. This paper describes the emotional, behavioural, social and functional factors that have been established to play a role in outcomes following cardiac surgery. This forms a basis for future research, testing the value of these factors above and beyond the physiological parameters. By including such non-physiological factors, the accuracy of the existing risk scoring systems could potentially be improved.

Keywords

Risk assessment cardiac surgery risk factors

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References

The Society of Thoracic Surgeons. Adult cardiac surgery database executive summary 10 years. 2017. Available at: https://www.sts.org/sites/default/files/documents/ACSD2017Harvest3_ExecutiveSummary.pdf

Von Kappelgaard

Davidsen

Gislason

Danish Heart Register – yearly numbers 2016. National Institute of Public Health, University of Southern Denmark. Available at: http://www.si-folkesundhed.dk/upload/dansk_hjerteregister_årsberetning_2016_anonymiseret.pdf

Bridgewater

Keogh

Kinsman

et al . Sixth national adult cardiac surgical database report. 2008. Available at: https://www.scts.org/_userfiles/resources/SixthNACSDreport2008withcovers.pdf

Hansen

Hjortdal

Andreasen

et al . 30-day mortality after coronary artery bypass grafting and valve surgery has greatly improved over the last decade, but the 1-year mortality remains constant. Ann Card Anaesth 2015; 18: 138–142.

Siregar

Groenwold

RHH

de Mol

BAJM

et al . Evaluation of cardiac surgery mortality rates: 30-day mortality or longer follow-up? Eur J Cardiothorac Surg 2013; 44: 875–883.

Hannan

Racz

Walford

et al . Predictors of readmission for complications of coronary artery bypass graft surgery. JAMA 2003; 290: 773–780.

Stewart

Campos

Jennings

et al . Predictors of 30-day hospital readmission after coronary artery bypass. Ann Thorac Surg 2000; 70: 169–174.

Iribarne

Chang

Alexander

et al . Readmissions after cardiac surgery: Experience of the national institutes of health/canadian institutes of health research cardiothoracic surgical trials network. Ann Thorac Surg 2014; 98: 1274–1280.

Sibilitz

Berg

Thygesen

et al . High readmission rate after heart valve surgery: A nationwide cohort study. Int J Cardiol 2015; 189: 96–104.

10.

Prins

de Villiers Jonker

Botes

et al . Cardiac surgery risk-stratification models. Cardiovasc J Afr 2012; 23: 160–164.

11.

Epstein

AJ.

Do cardiac surgery report cards reduce mortality? Assessing the evidence. Med Care Res Rev 2006; 63: 403–426.

12.

Granton

Cheng

Risk stratification models for cardiac surgery. Semin Cardiothorac Vasc Anesth 2008; 12: 167–174.

13.

Nashef

Roques

Michel

et al . European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16: 9–13.

14.

Nashef

SAM

Roques

Sharples

et al . Euroscore II. Eur J Cardiothoracic Surg 2012; 41: 734–745.

15.

Sullivan

Wallach

Ioannidis

JP.

Meta-analysis comparing established risk prediction models (EuroSCORE II, STS Score, and ACEF Score) for perioperative mortality during cardiac surgery. Am J Cardiol 2016; 118: 1574–1582.

16.

Celano

Huffman

JC.

Depression and cardiac disease: A review. Cardiol Rev 2011; 19: 130–142.

17.

Mallik

Krumholz

Lin

et al . Patients with depressive symptoms have lower health status benefits after coronary artery bypass surgery. Circulation 2005; 111: 271–277.

18.

Stenman

Holzmann

Sartipy

Relation of major depression to survival after coronary artery bypass grafting. Am J Cardiol 2014; 114: 698–703.

19.

Terada

Johnson

Norris

et al . Severe obesity is associated with increased risk of early complications and extended length of stay following coronary artery bypass grafting surgery. J Am Heart Assoc 2016; 5: 9–11.

20.

Zhao

Mei

et al . Impact of smoking on early clinical outcomes in patients undergoing coronary artery bypass grafting surgery. J Cardiothorac Surg 2015; 10: 16.

21.

Maheshwari

Dalton

Yared

J-P

et al . The association between alcohol consumption and morbidity and mortality in patients undergoing coronary artery bypass surgery. J Cardiothorac Vasc Anesth 2010; 24: 580–585.

22.

Koch

Kaplan

et al . Socioeconomic position, not race, is linked to death after cardiac surgery. Circ Cardiovasc Qual Outcomes 2010; 3: 267–276.

23.

Kaplan

Keil

JE.

Socioeconomic factors and cardiovascular disease: A review of the literature. Circulation 1993; 88: 1973–1998.

24.

Tang

Rashid

Godley

et al . Association between subjective social status and cardiovascular disease and cardiovascular risk factors: A systematic review and meta-analysis. BMJ Open 2016; 6: e010137.

25.

Mackenbach

Cavelaars

AEJM

Kunst

et al . Socioeconomic inequalities in cardiovascular disease mortality An international study. Eur Heart J 2000; 21: 1141–1151.

26.

Holme

Hjermann

Helgeland

et al . Coronary risk factors and socioeconomic status. The Oslo Study. Lancet 1976; 1396–1398.

27.

Smith

Hart

Watt

et al . Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: The Renfrew and Paisley Study. J Epidemiol Community Health 1998; 52: 399–405.

28.

Gonzalez

Artajejo

Calero

JDR

. Relationship between socioeconomic status and ischaemic heart disease in cohort and case-control studies: 1960–1993. Int J Epidemiol 1998; 27: 350–358.

29.

Alter

Naylor

Austin

et al . Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med 1999; 341: 1359–1367.

30.

Afilalo

Eisenberg

Morin

J-F

et al . Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 2010; 56: 1668–1676.

31.

Sepehri

Beggs

Hassan

et al . The impact of frailty on outcomes after cardiac surgery: A systematic review. J Thorac Cardiovasc Surg 2014; 148: 3110–3117.

32.

Grant

Booth

A typology of reviews: An analysis of 14 review types and associated methodologies. Health Info Libr J 2009; 26: 91–108.

33.

Tully

PJ.

Psychological depression and cardiac surgery: A comprehensive review. J Extra Corpor Technol 2012; 44: 224–232.

34.

Connerney

Shapiro

McLaughlin

et al . Relation between depression after coronary artery bypass surgery and 12-month outcome: A prospective study. Lancet 2001; 358: 1766–1771.

35.

Stenman

Holzmann

Sartipy

Association between preoperative depression and long-term survival following coronary artery bypass surgery – A systematic review and meta-analysis. Int J Cardiol 2016; 222: 462–466.

36.

Poole

Ronaldson

Kidd

et al . Pre-surgical depression and anxiety and recovery following coronary artery bypass graft surgery. J Behav Med 2017; 40: 249–258.

37.

Cserép

Balog

Székely

et al . Psychosocial factors and major adverse cardiac and cerebrovascular events after cardiac surgery. Interact Cardiovasc Thorac Surg 2010; 11: 567–572.

38.

Mallik

Krumholz

Lin

et al . Patients with depressive symptoms have lower health status benefits after coronary artery bypass surgery. Circulation 2005; 111: 271–277.

39.

Tully

Baker

Turnbull

et al . The role of depression and anxiety symptoms in hospital readmissions after cardiac surgery. J Behav Med 2008; 31: 281–290.

40.

Gardner

Worwood

EV.

Psychological effects of cardiac surgery: A review of the literature. J R Soc Health 1997; 117: 245–249.

41.

Joseph

Whitcomb

Taylor

Effect of anxiety on individuals and caregivers after coronary artery bypass grafting surgery. Dimens Crit Care Nurs 2015; 34: 285–288.

42.

Tully

PJ.

Quality-of-life measures for cardiac surgery practice and research: A review and primer. J Extra Corpor Technol 2013; 45: 8–15.

43.

Rumsfeld

MaWhinney

McCarthy

et al . Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. JAMA 1999; 281: 1298–1303.

44.

Smith

Hart

Blane

et al . Lifetime socioeconomic position and mortality: Prospective observational study. BMJ 1997; 314: 547–552.

45.

Alter

Naylor

Austin

et al . Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med 1999; 341: 1359–1367.

46.

Dickens

McGowan

Percival

et al . Lack of a close confidant, but not depression, predicts further cardiac events after myocardial infarction. Heart 2004; 90: 518–522.

47.

Haustein

K-O.

Smoking and poverty. Eur J Cardiovasc Prev Rehabil 2006; 13: 312–318.

48.

Schwarz

Schoberberger

Rieder

et al . Factors delaying treatment of acute myocardial infarction. Eur Heart J 1994; 15: 1595–1598.

49.

DiMatteo

Lepper

Croghan

TW.

Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160: 2101–2107.

50.

Murphy

Elliott

Le Grande

et al . Living alone predicts 30-day hospital readmission after coronary artery bypass graft surgery. Eur J Cardiovasc Prev Rehabil 2008; 15: 210–215.

51.

Cserép

Losoncz

Balog

et al . The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery. J Cardiothorac Surg 2012; 7: 1–8.

52.

Gerber

Goldbourt

Drory

Interaction between income and education in predicting long-term survival after acute myocardial infarction. Eur J Cardiovasc Prev Rehabil 2008; 15: 526–532.

53.

Badakhshan

Arab

Gholipour

et al . Heart surgery waiting time: Assessing the effectiveness of an action. Iran Red Crescent Med J 2015; 17: e24851.

54.

Pell

Norrie

et al . Effect of socioeconomic deprivation on waiting time for cardiac surgery: Retrospective cohort study. BMJ 2000; 320: 15–18.

55.

Barbash

Gaglia

Torguson

et al . Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization. Am Heart J 2013; 166: 729–736.

56.

Norekvål

Fridlund

Rokne

et al . Patient-reported outcomes as predictors of 10-year survival in women after acute myocardial infarction. Health Qual Life Outcomes 2010; 8: 140.

57.

Afilalo

Mottillo

Eisenberg

et al . Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes 2012; 5: 222–228.

58.

Feuchtinger

Halfens

Dassen

Pressure ulcer risk assessment immediately after cardiac surgery – does it make a difference? A comparison of three pressure ulcer risk assessment instruments within a cardiac surgery population. Nurs Crit Care 2007; 12: 42–49.

59.

Van der Mast

van

den

Broek

Fekkes

et al . Incidence of and preoperative predictors for delirium after cardiac surgery. J Psychosom Res 1999; 46: 479–783.

60.

Blumenthal

Lett

Babyak

et al . Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet 2003; 362: 604–609.

61.

Tully

Baune

Baker

RA.

Cognitive impairment before and six months after cardiac surgery increase mortality risk at median 11 year follow-up: A cohort study. Int J Cardiol 2013; 168: 2796–2802.

62.

Poole

Ronaldson

Kidd

et al . Pre-operative cognitive functioning and inflammatory and neuroendocrine responses to cardiac surgery. Ann Behav Med 2016; 50: 545–553.

63.

Institute of Medicine (US) Committee on Health and Behavior: Research Practice and Policy. Health and behavior: The interplay of biological, behavioral, and societal influences. Washington, DC: National Academy Press, 2001.

64.

Grabas

MPK

Hansen

Torp-Pedersen

et al . Alcohol consumption and mortality in patients undergoing coronary artery bypass graft (CABG) – a register-based cohort study. BMC Cardiovasc Disord 2016; 16: 1–10.

65.

Bluman

Mosca

Newman

et al . Preoperative smoking habits and postoperative pulmonary complications. Chest 1998; 113: 883–889.

66.

Saxena

Shan

Reid

et al . Impact of smoking status on early and late outcomes after isolated coronary artery bypass graft surgery. J Cardiol 2013; 61: 336–341.

67.

Jones

Nyawo

Jamieson

et al . Current smoking predicts increased operative mortality and morbidity after cardiac surgery in the elderly. Interact Cardiovasc Thorac Surg 2011; 12: 449–453.

68.

Pagano

Freemantle

Bridgewater

et al . Social deprivation and prognostic benefits of cardiac surgery: Observational study of 44 902 patients from five hospitals over 10 years. BMJ 2009; 338.

69.

Thomsen

Villebro

Møller

AM.

Interventions for preoperative smoking cessation. Cochrane Database Syst Rev 2014; 3: CD002294.

70.

Critchley

Capewell

Mortality risk reduction associated with smoking cessation in patients with coronary heart disease. JAMA 2003; 290: 86–97.

71.

Wagner

Grunwald

Rumsfeld

et al . Relationship of body mass index with outcomes after coronary artery bypass graft surgery. Ann Thorac Surg 2007; 84: 10–16.

72.

Wigfield

Lindsey

Muñoz

et al . Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI ⩾ 40. Eur J Cardiothoracic Surg 2006; 29: 434–440.

73.

Rockx

MAJ

Fox

Stitt

et al . Is obesity a predictor of mortality, morbidity and readmission after cardiac surgery? Can J Surg 2004; 47: 34–38.

74.

Rumsfeld

Alexander

Goff

et al . Cardiovascular health: The importance of measuring patient-reported health status: A scientific statement from the American Heart Association. Circulation 2013; 127: 2233–2249.

75.

World Health Organization. Basic documents. 48th edition. Geneva: WHO Press; 2014.

76.

Heidenreich

Spertus

Jones

et al . Health status identifies heart failure outpatients at risk for hospitalization or death. J Am Coll Cardiol 2006; 47: 752–756.

77.

Hoekstra

Jaarsma

van Veldhuisen

et al . Quality of life and survival in patients with heart failure. Eur J Heart Fail 2013; 15: 94–102.

78.

Biering

Nielsen

Rasmussen

et al . Return to work after percutaneous coronary intervention: The predictive value of self-reported health compared to clinical measures. PLoS One 2012; 7: e49268.

79.

Székely

Nussmeier

Miao

et al . A multinational study of the influence of health-related quality of life on in-hospital outcome after coronary artery bypass graft surgery. Am Heart J 2011; 161: 1179–1185.e2.

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