An examination of the difference in performance of self-care behaviours between white and non-white patients following CABG surgery: a secondary analysis

BACKGROUND

The demographic profile of the patient receiving coronary artery bypass graft (CABG) surgery in Canada has changed significantly over the past 20 years from mainly white (i.e., English, Irish, Scottish) to non-white (i.e., Indian or Chinese). To support individuals who have recently undergone a CABG procedure, patient education is provided to guide performance of self-care behaviours in the home environment. The relevance of this education, when applied to the current CABG surgery population, is questionable, as it was designed and tested using a white, homogenous sample. Thus, the number and type of self-care behaviours performed by persons of Indian and Chinese origin has not been investigated. These individuals may have varying self-care needs that are not reflected in the current self-care patient education materials.

PURPOSE

The intent of this study was to examine the difference in the type and number of self-care behaviours performed between white and non-white patients following CABG surgery.

METHODS

This study is a sub-study of a descriptive, exploratory design that included a convenience sample. Ninety-nine patients were recruited, representing three cultural groups (White, Indian, and Chinese). Descriptive data were used to describe the sample and identify specific self-care behaviours performed in the home environment.

FINDINGS

Results indicate statistically significant differences between white and non-white individuals related to use of incentive spirometer (p = 0.04), deep breathing and coughing exercises (p = 0.04), and activity modification (p < 0.05) at 1 week following hospital discharge.

IMPLICATIONS

Future research and theoretical exploration are required to assist in the understanding of the underlying mechanisms that contribute to the differences that are noted between white and non-white groups.

Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial

CONTEXT

Depressive symptoms commonly follow coronary artery bypass graft (CABG) surgery and are associated with less positive clinical outcomes.

OBJECTIVE

To test the effectiveness of telephone-delivered collaborative care for post-CABG depression vs usual physician care.

DESIGN, SETTING, AND PARTICIPANTS

Single-blind effectiveness trial at 7 university-based and community hospitals in or near Pittsburgh, Pennsylvania. Participants were 302 post-CABG patients with depression (150, intervention; 152, usual care) and a comparison group of 151 randomly sampled post-CABG patients without depression recruited between March 2004 and September 2007 and observed as outpatients until June 2008.

INTERVENTION

Eight months of telephone-delivered collaborative care provided by nurses working with patients' primary care physicians and supervised by a psychiatrist and primary care physician from this study.

MAIN OUTCOME MEASURES

Mental health-related quality of life (HRQL) measured by the Short Form-36 Mental Component Summary (SF-36 MCS) at 8-month follow-up; secondary outcome measures included assessment of mood symptoms (Hamilton Rating Scale for Depression [HRS-D]), physical HRQL (SF-36 PCS), and functional status (Duke Activity Status Index [DASI]); and hospital readmissions.

RESULTS

The intervention patients reported greater improvements in mental HRQL (all P < or = .02) (SF-36 MCS: Delta, 3.2 points; 95% confidence interval [CI], 0.5-6.0), physical functioning (DASI: Delta, 4.6 points; 95% CI, 1.9-7.3), and mood symptoms (HRS-D: Delta, 3.1 points; 95% CI, 1.3-4.9); and were more likely to report a 50% or greater decline in HRS-D score from baseline (50.0% vs 29.6%; number needed to treat, 4.9 [95% CI, 3.2-10.4]) than usual care patients (P < .001). Men with depression were particularly likely to benefit from the intervention (SF-36 MCS: Delta, 5.7 points; 95% CI, 2.2-9.2; P = .001). However, the mean HRQL and physical functioning of intervention patients did not reach that of the nondepressed comparison group.

CONCLUSION

Compared with usual care, telephone-delivered collaborative care for treatment of post-CABG depression resulted in improved HRQL, physical functioning, and mood symptoms at 8-month follow-up.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00091962.

Gender differences in coping and anxiety in patients after coronary artery bypass graft surgery in Taiwan

BACKGROUND

Greater use of coping strategies and lower anxiety levels may be related to positive outcomes after coronary artery bypass graft surgery; however, the relationship between them, including by gender, has not been examined in Taiwan.

METHODS

Cross-sectional survey research design and purposive sampling were used in this study, for which 50 men and 50 women were recruited from a medical center in northern Taiwan.

RESULTS

After coronary artery bypass graft surgery, both male and female patients used more problem-focused coping strategies than emotion-focused coping strategies. In comparison with men, women tended to use more blaming of self and had slightly higher scores on both state and trait anxiety.

CONCLUSION

Clinicians need to be aware that the use of appropriate coping strategies can reduce patient anxiety, a finding that needs to be considered when designing effective interventions for these patients.

Quality of life in young, professionally active men undergoing on-pump coronary artery bypass grafting--short-term follow-up results

BACKGROUND

The impact of coronary artery bypass grafting (CABG) on the quality of life (QoL) is one of the important measures of the efficacy of the procedure. This issue in young, professionally active male patients has not been extensively studied.

AIM

To assess QoL before and after on-pump CABG, and before and after cardiac rehabilitation in young men with low operative risk.

METHODS

The study group comprised 50 men aged 54.4 +/- 5.6 years who were professionally active before the surgery. The QoL was assessed on the basis of the MacNew questionnaire (in points). We analysed QoL changes and effects of basic demographic and peri-operative data on QoL during a short-term follow-up.

RESULTS

All components of QoL deteriorated shortly after CABG: emotional - from 4.97 +/- 0.96 to 4.66 +/- 1.0 (p = 0.03); physical - from 4.49 +/- 1.1 to 4.2 +/- 1.2 (p = 0.02); and social - from 4.68 +/- 1.0 to 4.47 +/- 1.1 (p = 0.1). Pre-operative physical and social QoL positively correlated with age (r = 0.45 and r = 0.37, respectively) and left ventricular ejection fraction (LVEF) (r = 0.49 and r = 0.48, respectively). However, there was a negative impact of history of myocardial infarction on physical QoL (p < 0.05). A negative influence of cardiopulmonary bypass time (r = -0.45) and cross-aortic clamp time (r = -0.36) on physical QoL was also noted. The QoL values were also influenced by class of angina symptoms (R = -0.33 / -0.42), total drainage (r = -0.11 / -0.34) and quantity of grafts (R = -0.35 / -0.42). During rehabilitation, QoL significantly improved: emotional - from 5.29 +/- 0.92 to 5.96 +/- 0.9 (p = 0.01); physical - from 4.66 +/- 1.1 to 5.42 +/- 1.2 (p < 0.01); and social - from 4.69 +/- 1.2 to 5.65 +/- 1.1 (p < 0.01). The QoL during rehabilitation was correlated with baseline peri-operative risk (for logistic EuroSCORE algorithm r = -0.21 / -0.31 and for EuroSCORE R = -0.47 / -0.89). Significant determinants of some components of QoL were also LVEF (r= 0.26 / 0.47), morphological blood parameters (r = 0.37 / 0.43), baseline CCS class (R = 0.31 / 0.58), age (r = -0.41 / -0.83), and extent of surgery defined by cardiopulmonary bypass time, cross-aortic clamp duration and total drainage.

CONCLUSIONS

Quality of life in young, professionally active men significantly deteriorates a few days after on-pump CABG but systematically improves during the next weeks, particularly after rehabilitation. Pre-operative QoL correlates positively with age and LVEF, and negatively with a history of myocardial infarction. Age, pre-operative risk, angina symptoms and the extent of surgery have negative effects on physical QoL after CABG during short-term observation.

Effects of progressive muscular relaxation training on quality of life in anxious patients after coronary artery bypass graft surgery

BACKGROUND & OBJECTIVE

Evidences suggest that relaxation therapy may improve psychological outcomes in heart patients. We evaluated the effect of progressive muscular relaxation (PMR) training in decreasing anxiety and improving quality of life among anxious patients after coronary artery bypass graft surgery (CABG).

METHODS

This study was an open uncontrolled trial. The sample included 110 anxious patients referred to the cardiac rehabilitation clinic of Tehran Heart Center, Tehran, Iran, during six weeks after coronary artery bypass graft (CABG). Patients were allocated to receive both exercise training and lifestyle education plus relaxation therapy (relaxation group; n=55) or only exercise training beside lifestyle education (control group or the recipient of usual care group; n=55). Duration of the relaxation therapy was 6 wk and in the case of usual care was 8 wk. Both the groups were followed up one month after completion of intervention. Anxiety and quality of life in the two treatment groups were compared.

RESULTS

There were no significant differences in overall QOL, state anxiety and trait anxiety scores between the two groups before intervention. Significant reductions in state anxiety (P<0.01) and trait anxiety (P<0.01) levels were observed in relaxation group after intervention compared to control group. Women had high state anxiety and a low quality of life than men in the two groups before intervention. After intervention, there was no difference between men and women in the relaxation group.

INTERPRETATION & CONCLUSION

Our findings show that progressive muscular relaxation training may be an effective therapy for improving psychological health and quality of life in anxious heart patients.

The Bypassing the Blues treatment protocol: stepped collaborative care for treating post-CABG depression

OBJECTIVE

To present the design of the Bypassing the Blues (BtB) study to examine the impact of a collaborative care strategy for treating depression among patients with cardiac disease. Coronary artery bypass graft (CABG) surgery is one of the most common and costly medical procedures performed in the US. Up to half of post-CABG patients report depressive symptoms, and they are more likely to experience poorer health-related quality of life (HRQoL), worse functional status, continued chest pains, and higher risk of cardiovascular morbidity independent of cardiac status, medical comorbidity, and the extent of bypass surgery.

METHODS

BtB was designed to enroll 450 post-CABG patients from eight Pittsburgh-area hospitals including: (1) 300 patients who expressed mood symptoms preceding discharge and at 2 weeks post hospitalization (Patient Health Questionnaire (PHQ-9) >or=10); and (2) 150 patients who served as nondepressed controls (PHQ-9 <5). Depressed patients were randomized to either an 8-month course of nurse-delivered telephone-based collaborative care supervised by a psychiatrist and primary care expert, or to their physicians' "usual care." The primary hypothesis will test whether the intervention can produce an effect size of >or=0.5 improvement in HRQoL at 8 months post CABG, as measured by the SF-36 Mental Component Summary score. Secondary hypotheses will examine the impact of our intervention on mood symptoms, cardiovascular morbidity, employment, health services utilization, and treatment costs.

RESULTS

Not applicable.

CONCLUSIONS

This effectiveness trial will provide crucial information on the impact of a widely generalizable evidence-based collaborative care strategy for treating depressed patients with cardiac disease.

The relationship between CABG patient characteristics and perceived learning needs: a secondary analysis

BACKGROUND

Patients' learning needs are influenced by socio-cultural characteristics such as level of formal education, sex, and age. Limited research has examined this influence.

PURPOSE

The purpose of this study was twofold: 1) to describe the number and type of learning needs identified among first-time CABG patients, and 2) to examine the relationships between learning needs and socio-cultural characteristics (education, sex, and age).

DESIGN

This study was a sub-study of a randomized clinical trial (RCT) that evaluated the most appropriate time for delivering education to patients who had CABG surgery.

SAMPLE

Individuals having CABG with one to four grafts for the first time and who were literate and cognitively oriented to person, place, and time were included in this study.

ANALYSIS

Descriptive and correlation statistics were used to analyze the data.

RESULTS

A significant difference between learning needs and sex (p = 0.00) was noted, while a significant relationship between learning needs and age (p = 0.03) was identified.

CONCLUSION

This study represents a first step towards identifying the association between perceived learning needs and socio-cultural characteristics.

Relationship of genetic variability and depressive symptoms to adverse events after coronary artery bypass graft surgery

OBJECTIVE

To assess genetic variability in two serotonin-related gene polymorphisms (MAOA-uVNTR and 5HTTLPR) and their relationships to depression and adverse cardiac events in a sample of patients undergoing coronary artery bypass surgery.

METHODS

A total of 427 coronary artery bypass graft (CABG) patients were genotyped for two polymorphisms and assessed for depressive symptoms at three time points, in accordance with the Center for Epidemiological Studies-Depression (CES-D): preoperative baseline; 6 months postoperative; and 1 year postoperative. Logistic regression was used to assess the association between depressive symptoms (CES-D = >16), genotype differences, and cardiac events. Because MAOA-uVNTR is sex-linked, males and females were analyzed separately for this polymorphism; sexes were combined for the 5HTTLPR analysis.

RESULTS

Depressed patients were more likely than nondepressed patients to have a new cardiac event within 2 years of surgery (p < .0001); depressed patients who carry the long (L) allele of the 5HTTLPR polymorphism were more likely than the short/short (S/S carriers to have an event (p = .0002). Genetic associations with 6-month and 1-year postoperative depressive symptoms do not survive adjustment for baseline depressive symptoms.

CONCLUSIONS

A serotonin-related gene polymorphism--5HTTLPR--was associated with adverse cardiac events post CABG, in combination with depressive symptoms. Because depressed patients with the L allele of the 5HTTLPR polymorphism were more likely to have an event compared with the S/S carriers, combining genetic and psychiatric profiling may prove useful in identifying patients at the highest risk for adverse outcomes post CABG.

Coronary Artery Bypass Grafting: Patients' and Health Professionals' Views of Recovery After Hospital Discharge

Background: Coronary artery bypass grafting (CABG) is effective in relieving symptoms and reducing mortality but some patients report no improvement or a decline in quality of life and hence do not experience a good recovery after surgery. Little published research has explored patients' and particularly health professionals' views on barriers and facilitators to recovery or the processes by which these factors affect recovery.

Aims: To identify post-discharge facilitators and barriers to recovery after CABG.

Methods: Semi-structured interviews were conducted with 11 patients who had previously undergone elective, isolated, first-time CABG and with 10 health professionals experienced in caring for these patients.

Results: Thematic analysis identified the following themes: person characteristics, including the impact on recovery of anxiety, depression, optimism and determination; rehabilitation classes; social support; and the effect of surgery. Findings indicate a complex relationship between the various barriers and facilitators to recovery and explore possible processes by which these influences on recovery operate.

Conclusions: Findings have indicated areas where health professionals can intervene to aid patients' long-term recovery, and thereby maximise the benefits of CABG, by providing information, support and reassurance particularly to patients who appear anxious and/or depressed.

Patients Reported Health-Related Quality of Life Five Years Post Coronary Artery Bypass Graft Surgery – A Methodological Study

Background: The number of individuals undergoing Coronary Artery Bypass Graft Surgery (CABGS) to treat coronary artery disease is steadily increasing.

Aim: The purpose of the study was to describe the cohort's characteristics, their angina and breathless symptoms and report health-related quality of life (HRQoL) five years after CABGS.

Methods: One hundred and twenty-eight patients participated in the follow-up study using the quality of life Short-Form 36 (SF-36) questionnaire. Angina and breathless symptoms were also recorded.

Results: One hundred and nine patients were interviewed (face-to-face) and 19 completed postal questionnaires. The SF-36 component summaries of the face-to-face patients indicated that their physical (PCS) and mental (MCS) health was relatively good (45.8 and 53.6, respectively, with 0 = worst health and 100 = best health and 50 being the mean score), compared to the postal patients' mean PCS of 30.8 ( p < .001). The postal MCS was also lower but not statistically significant (49.6, p = .081). At follow-up, the majority of patients were asymptomatic in terms of angina and breathlessness compared to their pre-operative status.

Conclusion: The findings demonstrate that patient perceived HRQoL five years after CABGS is generally good and patients remain relatively asymptomatic although data collection methods highlight differences in physical HRQoL.

The effect of anxiety on learning outcomes post-CABG

Post-operative coronary artery bypass graft (CABG) patients require educational interventions to support recovery and prevention of surgical complications. However, the effectiveness of these interventions is questionable, as stress related to the hospitalization process can result in increased levels of anxiety that may impact on the success of the education. The purpose of this study was to examine the relationship between anxiety and the achievement of knowledge, use of self-care behaviours, and management of symptoms. A descriptive correlation design was used, which included a convenience sample. Results indicate statistically significant correlations between anxiety and the outcomes ofinterest. Implications for practice include provision of educational interventions at times when anxiety levels are low.

Nurse training of a patient-centered information procedure for CABG patients

OBJECTIVE

At the study hospital, all elective coronary artery bypass graft (CABG) surgery patients were given similar, standardized information by the nurses. The nurses reported problems in establishing contact and interacting with patients when using this approach. To help remedy communication problems between nurses and CABG patients, a programme training nurses in a patient-centred information procedure was developed and implemented. This article describes how challenging interactions were recorded and analysed for training nurses in the patient-centred approach.

METHOD

In group training for patient-centeredness, nurses presented audio-recordings of nurse-patient interactions they found problematic. These were used as a basis for discussions and training in the patient-centered approach. A set of cases was developed using a qualitative phenomenological approach, illustrating how the patient-centered approach could be applied to the difficult situations.

RESULTS

The nurses found the patient-centered approach particularly useful in situations when patients frequently asked questions, seemed to have difficulties expressing their worries, frequently complained, or when spouses expressed worries.

CONCLUSION

Nurses found the patient-centered approach and the training procedure used in this study useful in their clinical work with CABG patients.

PRACTICE IMPLICATIONS

This training which requires minimal resources and can be easily implemented, may guide the nurses in their interaction with patients. Providing a patient-centered approach to the CABG patients may enhance the nurse-patient contact and improve patients' hospital experience and subjective health.

Illness representations and psychological distress in patients undergoing coronary artery bypass graft surgery

Preoperative psychological distress has been shown to predict both postoperative distress and subsequent cardiac morbidity in patients undergoing coronary artery bypass graft (CABG) surgery. This study assessed the associations between illness perceptions and psychological well-being among 56 patients awaiting CABG surgery using the Profile of Mood States (POMS) and the Illness Perception Questionnaire-Revised (IPQ-R). Patient perceptions of their illness as chronic were associated with reduced beliefs in both personal control over illness and efficacy of treatment, and increased perceived consequences of illness in terms of life functioning. In addition, psychological distress regarding illness was significantly correlated with psychological distress in general. Reduced illness coherence was also associated with increased psychological distress. Preoperative psycho-education aimed at helping patients better understand their illness, treatment, and its effects may reduce psychological distress, and perhaps improve future well-being as a result.

[Relationship of preoperative anxiety-state and anxiety-trait in patients qualified for coronary artery bypass graft surgery to the perception of postoperative pain and other pain complaints]

INTRODUCTION

The study investigated relationships of postoperative pain following coronary artery bypass graft (CABG) surgery with two variables: (1) level of preoperative anxiety (anxiety-state) and (2) level of anxiety-trait.

MATERIAL AND METHODS

Eighty three randomly selected male patients (44-66 years old), qualified for CABG surgery, participated in the study. All of them were patients at the Cardiosurgery Medical Centre of Pomeranian Medical University. It was a prospective clinical study. Anxiety-state and anxiety-trait were measured in the preoperative period using a Polish version of STAI. During the postoperative period the following factors of postoperative pain were measured, using a modified version of McGill Pain Questionnaire: average level of perceived postoperative pain, level of extreme pain, pain frequency, degree of pain regression following analgesia and number of other pain complaints.

RESULTS

A significant relationship of the level of preoperative anxiety-state and anxiety-trait with the degree of pain regression within the postoperative wound following the administration of medication (analgesia efficiency) was found (p < 0.01 and 0.001, respectively). Additionally, a significant relationship was found between the level of anxiety-trait with the level of perceived extreme postoperative pain (p < 0.01) and with the number of other pain complaints (p < 0.1).

CONCLUSIONS

This investigation confirmed that relationships of anxiety and pain reported in other research are true also for CABG patients. It has been also observed that patients with a high level of preoperative anxiety-state and stronger anxiety-trait respond worse to analgesic medication than patients with a low level of anxiety-state and anxiety-trait. Therefore, actions undertaken to reduce patients' anxiety may reduce patients' need of analgesic medications.

[Prayers for patients with internal and cardiological diseases--an applicable therapeutic method?]

Previous intercessory prayer studies showed symptom improvement and lower rates of complications in patients who were prayed for, whether it was a direct prayer or a distant intercessory prayer. The effect of intercessory prayer was not observed in cardiology patients during two new multicentre studies (MANTRA, STEP). The STEP study actually showed an unfavourable effect when the patient knew of distant prayers made on his/her behalf. Thus, prayer as an "applicable therapeutic method" could not be empirically verified. However, active prayer within the framework of a doctor-patient relationship can strengthen the patient's optimism and activate the body's healing resources.

Physical, psychological and social recovery patterns after coronary artery bypass graft surgery: A prospective repeated measures questionnaire survey

AIM

This study examined the physical, psychological and social recovery patterns of Hong Kong Chinese patients who have undergone CABG surgery over a period of six months.

BACKGROUND

Recovery from coronary artery bypass graft (CABG) surgery is a dynamic process and the associated physical, psychological and social effects could lead to failure to recuperate leading to hospital re-admission and morbidity.

DESIGN

A prospective repeated measures design was used for this research. Patients were interviewed in person 5 days before surgery and at 1 week after discharge, and by telephone at 3 and 6 months after discharge. Physical recovery dimension was assessed by three categories of the Sickness Impact Profile (ambulation, sleep-rest, body movement and care). Social recovery dimension was assessed by three categories of the Sickness Impact Profile (SIP) (home management, social interaction, and recreation and pastimes). Psychological recovery was assessed using the Centre for Epidemiologic Studies-Depression (CES-D).

RESULTS

Sixty-eight patients participated in this research. The mean physical SIP-dimension score and depression level at discharge was the highest then gradually decreased at 6 months after CABG. The SIP-physical and SIP-social and depression level differed significantly across the four-assessment time within-group. There were no gender differences in physical and social recovery and depression levels. Patients who had poorer physical and social recovery had more depression at one week and three months after CABG surgery.

CONCLUSION

Patients should be prepared for discharge after CABG surgery. Cultural factors may have influenced the similar recovery patterns between genders. These factors contributing to early recovery must be further examined.

RELEVANCE TO CLINICAL PRACTICE

Because of the large number of patients who undergo CABG worldwide, and because of healthcare cost related to this intervention, it is important for both patients and healthcare providers to have realistic expectations about the recovery process and to recognise deviations from the norm. The results provided some insights into the Hong Kong Chinese patients' recovery from CABG surgery that would guide the development of culturally appropriate pre-operative and discharge teaching for this group of patients.

Blending mental healthcare and traditional models

Investigators try to develop new approaches to care that take into account this significant risk factor.

Impact of cardiac rehabilitation on depression and its associated mortality

PURPOSE

Depression following major cardiac events is associated with higher mortality, but little is known about whether this can be reduced through treatment including cardiac rehabilitation and exercise training. We evaluated the impact of cardiac rehabilitation on depression and its associated mortality in coronary patients.

PATIENTS AND METHODS

We evaluated 522 consecutive coronary patients (381 men, 141 women; aged 64+/-10 years) enrolled in cardiac rehabilitation from January 2000 to July 2005 and a control group of 179 patients not completing rehabilitation. Depressive symptoms were assessed by questionnaire at baseline and following rehabilitation, and mortality was evaluated after a mean follow-up of 1296+/-551 days.

RESULTS

Prevalence of depressive symptoms decreased 63% following rehabilitation, from 17% to 6% (P <.0001). Depressed patients following rehabilitation had an over 4-fold higher mortality than nondepressed patients (22% vs 5%, P=.0004). Depressed patients who completed rehabilitation had a 73% lower mortality (8% vs 30%; P=.0005) compared with control depressed subjects who did not complete rehabilitation. Reductions in depressive symptoms and its associated mortality were related to improvements in fitness; however, similar reductions were noted in those with either modest or marked increases in exercise capacity.

CONCLUSION

In patients following major coronary events, cardiac rehabilitation is associated with both reductions in depressive symptoms and the excess mortality associated with it. Moreover, only mild improvements in levels of fitness appear to be needed to produce these benefits on depressive symptoms and its associated mortality.

Relation of depression, natural killer cell function, and infections after coronary artery bypass in women

BACKGROUND

After hospital discharge for coronary artery bypass grafting (CABG), infection is a common cause of morbidity. Although depression has been associated with immune dysfunction, its role in post-CABG infection is unknown.

AIMS

The purpose of this study was to: 1) compare natural killer cell cytotoxicity (NKCC) and post-hospitalization infections in depressed and non-depressed women after CABG; and 2) test whether NKCC mediated the relationship between post-discharge depression and infections.

METHODS

Sixty-seven women recovering from CABG were assessed for depression prior to hospital discharge and followed for six months. Major depression was identified by a structured clinical interview. Infections were identified by patient report using the Modified Health Review and by medical chart audit.

RESULTS

Compared to non-depressed women after CABG, women with major depression had reduced NKCC, more all-cause infections, and more self-reported illnesses. Although NKCC did not mediate the relationship between depression and wound (i.e. incisional) infections after CABG, it did mediate the relationship between depression and non-wound infections, including pneumonias and upper respiratory infections.

CONCLUSIONS

For the first six months after CABG, women with major depression are at increased risk for infections. Natural killer cell cytotoxicity may be related to this phenomenon, particularly to non-wound infections.

Quality of life after coronary artery bypass surgery

This study assessed the quality of life (QoL) of 124 people with coronary artery disease who had coronary artery bypass surgery in a hospital in Brazil, by using the Modified Flanagan's QoL instrument as the outcome measure. In addition, we studied the association between QoL and demographic, clinical, and perceived health status (using SF-36 Health Survey) measures. The mean for the Modified Flanagan's QoL was high (M = 84.8, SD = 13.6) when compared to similar studies in the United States. In a linear regression analysis, the SF-36 subscales of vitality, and general and mental health were statistically significant (p < .01 for all), after adjusting for other demographic and clinical variables. Increasing values of those SF-36 subscales corresponded to increasing Modified Flanagan's QoL. Despite the limitations of the study, this result suggests that future clinical interventions aimed to improve QoL in this population could focus on the patient's psychological conditions after the surgery.

Association of Age and Quality of Life Following Phase II Cardiac Rehabilitation

The benefits of cardiac rehabilitation following a major cardiac event are without question. Less well known, however, is the association of age with improved quality of life following rehabilitation. Subjects (n = 300) completed a 3-month phase II cardiac rehabilitation program following either a coronary artery bypass graft or a valve procedure. There were similar gains in health-related quality of life across all age groups; our results suggest that there needs to be a greater focus on emotional needs among our younger patients.