Predictors of poor mid-term health related quality of life after primary isolated coronary artery bypass grafting surgery

Abstract

Objective: To assess the determinants of poor mid-term health related quality of life (HRQoL) at one year after primary isolated coronary artery bypass grafting (CABG). Methods: 463 patients who underwent primary isolated CABG for multivessel disease and came for their annual follow up at the outpatient clinic during one year at Harefield Hospital, Middlesex, were approached to participate in the present study. Prospective clinical data were collected as part of the clinical care of the patients and were retrospectively analysed when the patients consented to participate in the study at their outpatient visit. After their consent they were given three HRQoL assessment questionnaires. Scores, together with clinical data, were analysed by both univariate and multivariate analyses with regard to poor HRQoL outcome. Results: 437 (94.4%) patients consented to participate in the study and filled in the HRQoL questionnaires. Ten variables were identified in the univariate analysis as potential predictors of poor scores of the physical element of HRQoL; however, only three variables-gastrointestinal problems, congestive heart failure, and type D personality trait-predicted poor physical scores independently. Eleven variables were identified in the univariate analysis as potential predictors of poor scores of the mental element of HRQoL; however, only three variables-peripheral vascular disease, infective complications, and type D personality trait-predicted poor physical scores independently. Conclusion: Preoperative gastrointestinal problems, preoperative congestive heart failure, and type D personality trait were independent predictors of the poor physical component of HRQoL. Peripheral vascular disease, infective complications, and type D personality trait were independent predictors of the poor mental component of HRQoL. Interestingly, patients with type D personality were more than twice as likely to have poor physical HRQoL and more than five times as likely to have poor mental HRQoL.

Type D Patients Report Poorer Health Status Prior to and After Cardiac Rehabilitation Compared to Non-Type D Patients

“…The findings of the current study are in line with previous studies in patients with peripheral arterial disease [13], treated with revascularization procedures [16,35], and patients with chronic heart failure [14], showing that Type D patients report poorer health status compared to non-Type D patients despite both personality taxonomies benefiting from medical treatment. In the present study, we found a non-significant interaction effect for Type D personality by time, indicating that personality did not moderate the effects of cardiac rehabilitation on health status but exerted a stable effect on health status over time.…”

“…Preliminary evidence indicates that hostile patients may experience more benefits from cardiac rehabilitation in terms of reductions in anxiety and improvement in quality of life [10]. Type D personality is an emerging risk factor in cardiovascular disease that has been shown to predict adverse health outcomes in CAD [11,12], peripheral arterial disease [13], chronic heart failure [14], patients with life-threatening arrhythmias [15], and patients treated with revascularization procedures [16]. Type D is defined by the two normal and stable personality traits Negative Affectivity [17] and Social Inhibition [18].…”

Estimation of Cardiac Surgery Results

“…Thus, our study and data from literature sources [4][5][8][9][10][11] show that the increase of post-operative complications, the severity of pain syndrome, prolongation of hospitalization, and rehabilitation period occur in patients after extensive thoracotomy.…”

“…Literary sources indicate that after sternotomy and cardiac surgeries the mediastinitis occurs during the post-operative period in 3% of cases; the pyoinflammatory complications are observed in 20% of patients [4][5][8][9][10][11]. The risk factors for the development of pyoinflammatory complications are repeated surgeries, females, obesity, diabetes mellitus, multifocal atherosclerosis, coronary artery bypass grafting, infective endocarditis, post-operative pneumonia, and urinary tract infections.…”

“…The open sources provide data on the annual financial costs in one of the USA thoracic surgery hospitals' expenditures for the treatment of complications among patients after performing the surgical interferences by means of sternotomy, and these expenditures amount to half a million dollars [4,5,[8][9][10][11].…”