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Alzahrani AA, AlAssiri AK, Al-Ebrahim KE, Ganbou ZT, Alsudais MM, Khafagy AM. Impact of Clinical and Sociodemographic Factors on Quality of Life Following Coronary Artery Bypass Grafting: A Mixed-Methods Study. Cureus 2024; 16:e56781. [PMID: 38650792 PMCID: PMC11034901 DOI: 10.7759/cureus.56781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Coronary artery bypass grafting (CABG) is an essential surgical management modality for patients with coronary artery disease. Health-related quality of life (HRQoL) has become important because of the significant decrease in the mortality rate associated with CABG. We aimed to explore the factors that affect the quality of life after CABG. METHODS This study used a descriptive correlational design to assess the determinants of HRQoL using the 36-item Short Form Health Survey questionnaire (SF-36). Patients who underwent CABG at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between March 2015 and December 2021 were enrolled in this study. Overall, 275 participants were eligible for our study, of which 84 were found to be valid for analysis. Phone contacts were made directly with the patient after briefly explaining the study. Scores and clinical data were investigated using multivariable linear regression analysis. RESULTS Subscales of role limitations due to physical issues had the lowest mean scores, followed by vitality and general health (57.4 ± 44.7; 60.4 ± 25.6; 64.1 ± 22.6), respectively. However, social functioning (78.9 ± 29.0) and pain (75.1 ± 29.9) had the highest scores of all subscales. A history of congestive heart failure (CHF) was independently associated with lower scores for physical role limitations (p = 0.021), vitality (p = 0.001), general health (p< 0.001), and mental health (p = 0.011). Lower mental health scores were also predicted by being a widow (p = 0.030), whereas lower general health scores were predicted by being unemployed (p = 0.001) and having a peripheral vascular disease (PVD) (p = 0.043). Additionally, the development of postoperative complications was an independent predictor of lower physical functioning (p = 0.028) and vitality (p = 0.043). Regarding the number of grafts, cardiopulmonary bypass, and cross-clamp time, no significant impact was found on any of the SF-36 subscales (p> 0.05). CONCLUSION The postoperative decline in HRQoL was attributed to comorbidities such as CHF and PVD, postoperative complications including bleeding and wound infection, as well as unemployment and widowed status. Therefore, choosing the appropriate patients for surgery and post-discharge follow-up may enhance HRQoL.
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Affiliation(s)
| | - Abdullah K AlAssiri
- Cardiac Surgery, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
| | | | - Zeyad T Ganbou
- Cardiac Surgery, King Abdulaziz University Hospital, Jeddah, SAU
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Lachonius M, Giang KW, Lindgren M, Skoglund K, Pétursson P, Silverborn M, Jeppsson A, Nielsen SJ. Socioeconomic factors and long-term mortality risk after surgical aortic valve replacement. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200223. [PMID: 38023350 PMCID: PMC10661603 DOI: 10.1016/j.ijcrp.2023.200223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/09/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
Background There is scarce knowledge about the association between socioeconomic status and mortality in patients undergoing surgical aortic valve replacement. This study explores the associations between income, education and marital status, and long-term mortality risk. Methods In this national registry-based observational cohort study we included all 14,537 patients aged >18 years who underwent isolated surgical aortic valve replacement for aortic stenosis in Sweden 1997-2020. Socioeconomic status and comorbidities were collected from three mandatory national registries. Cox regression models adjusted for patient characteristics and comorbidities were used to estimate the mortality risk. Results Mortality risk was higher for patients in the lowest versus the highest income quintile (adjusted hazard ratio [aHR] 1.36, 95 % confidence interval [CI]: 1.11-1.65), for patients with <10 years education versus >12 years (aHR 1.20, 95 % CI:1.08-1.33), and for patients who were not married/cohabiting versus those who were (aHR 1.24, 95 % CI:1.04-1.48). Patients with the most unfavorable socioeconomic status (lowest income, shortest education, never married/cohabiting) had an adjusted median survival of 2.9 years less than patients with the most favorable socioeconomic status (14.6 years, 95 % CI: 13.2-17.4 years vs. 11.7 years, 95 % CI: 9.8-14.4). Conclusions Low socioeconomic status in patients undergoing surgical aortic valve replacement is associated with shorter survival and an increased long-term adjusted mortality risk. These results emphasize the importance of identifying surgical aortic valve replacement patients with unfavorable socioeconomic situation and ensure sufficient post-discharge surveillance.
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Affiliation(s)
- Maria Lachonius
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Sahlgrenska University Hospital/Östra, Department of Medicine, Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Sahlgrenska University Hospital/Östra, Department of Medicine, Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden
| | - Kristofer Skoglund
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pétur Pétursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Silverborn
- Sahlgrenska University Hospital/Östra, Department of Medicine, Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne J. Nielsen
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Hämäläinen L, Kohonen M, Laurikka J. Health-related quality of life is improved after coronary artery bypass graft surgery: a 1-year follow-up study. SCAND CARDIOVASC J 2023; 57:2284083. [PMID: 38010887 DOI: 10.1080/14017431.2023.2284083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 11/11/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The purpose of this study was to detect changes in QoL after coronary artery bypass grafting surgeries (CABG) in one year, and to identify the possible predictive factors associated with the change. DESIGN A single-center prospective study of 501 patients was conducted between 2013 and 2018 using the EQ-5D VAS questionnaire for estimating the QoL. The patients filled in a questionnaire preoperatively, at 6 and at 12 months postoperatively. Univariate and multivariable logistic regression analyses were used to find out if certain pre-selected factors or EQ5D dimensions had independent effects on the observed EQ VAS scores. RESULTS QoL improved in all EQ-5D dimensions and in EQ VAS scores at 6 and at 12 months: the greatest changes in the number of reported problems were in the dimensions "mobility" (-34.2%, p<.001), "self-care" (-36.7%, p=.001) and "pain or discomfort" (-31.0%, p<.001). With the multivariable regression model, we could show that normal left ventricle ejection fraction (LVEF) and improvement in mobility and pain/discomfort dimensions were in association with improvement of EQ VAS score at 6 months. At 12 months this association was no longer detectable. CONCLUSIONS CABG procedure can improve patient's QoL when judged with EQ5D dimensions and related overall self-rated health (VAS). This improvement was seen both at 6 and at 12 months postoperatively. Except for LVEF, the other patient-specific risk factors we examined did not seem to affect QoL in the long term.
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Affiliation(s)
- Laura Hämäläinen
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Mika Kohonen
- Tampere University Hospital Heart Center, Tampere, Finland
| | - Jari Laurikka
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
- Tampere University Hospital Heart Center, Tampere, Finland
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Axon DR, Grieser M. Characteristics Associated with Multimorbidity among Older United States Adult Opioid Users with Pain. J Clin Med 2023; 12:6684. [PMID: 37892821 PMCID: PMC10607778 DOI: 10.3390/jcm12206684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
The objective of this study was to investigate the variables associated with multimorbidity status among older United States (US) adults with self-reported pain and opioid use. This study used a cross-sectional retrospective database design that included US adults aged ≥50 years with self-reported pain who used an opioid in 2019 in the Medical Expenditure Panel Survey data. Multivariable logistic regression models, weighted to produce nationally representative estimates, were used to determine variables significantly associated with multimorbidity status (≥2 versus <2 chronic conditions). Significance was determined using an a priori alpha level of 0.05. In the adjusted logistic regression analysis, those aged 50-64 (vs. ≥65 years), Hispanic (vs. non-Hispanic), employed (vs. unemployed), and who performed frequent exercise (vs. no frequent exercise) were associated with lower odds of having multimorbidity. In conclusion, these characteristics may be targets for pain management and opioid use interventions among older US adults. Further research is needed to investigate the variables associated with multimorbidity in greater detail.
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Affiliation(s)
- David R. Axon
- Department of Pharmacy Practice & Science, R. Ken Coit College of Pharmacy, University of Arizona, 1295 N Martin Ave., P.O. Box 210202, Tucson, AZ 85721, USA;
- Center for Health Outcomes and PharmacoEconomic Research (HOPE Center), R. Ken Coit College of Pharmacy, University of Arizona, 1295 N Martin Ave., P.O. Box 210202, Tucson, AZ 85721, USA
| | - Megan Grieser
- Department of Pharmacy Practice & Science, R. Ken Coit College of Pharmacy, University of Arizona, 1295 N Martin Ave., P.O. Box 210202, Tucson, AZ 85721, USA;
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Newell P, Zogg C, Shirley H, Feliz J, Hirji S, Harloff M, Kerolos M, Shah P, Kaneko T. The Effect of Psychosocial Risk Factors on Outcomes After Aortic Valve Replacement. JACC Cardiovasc Interv 2022; 15:2326-2335. [DOI: 10.1016/j.jcin.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022]
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Zhang W, Xie S, Xue F, Liu W, Chen L, Zhang L, Wu J, Yang R. Health-related quality of life among adults with haemophilia in China: A comparison with age-matched general population. Haemophilia 2022; 28:776-783. [PMID: 35751903 DOI: 10.1111/hae.14615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/22/2022] [Accepted: 06/11/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Evaluating health-related quality of life (HRQoL) is vital for informing the improvement of the overall health of people with haemophilia (PwH). While there is lacking such data in China and comparisons with the general population. AIM To evaluate the HRQoL and its associated factors among adults with haemophilia, and compare it with a sample of the general population in China. METHODS PwH were recruited in this study using telephone-based interviews. Demographic and clinical characteristics were first collected. HRQoL was then evaluated using the self-reported Short Form 6-dimensions version 2 (SF-6Dv2) instrument. An age and gender-matched sample of the general population in China was also included as the comparator group. Linear regression was used to assess the association between the SF-6Dv2 utility value and the demographic and clinical variables of the patients. RESULTS This study included 206 PwH (mean [SD] age: 41.36 [14.48] years) and 206 respondents from the general population. PwH reported worse levels in physical functioning, role limitation, social functioning, and mental health dimensions on SF-6Dv2 than the general respondents. The mean (SD) utility of patients was .650 (.251), which was significantly lower than the general respondents (.786 [.183], P < .001). Being a student, having a higher monthly income, absence of comorbidities, having no target joints and requiring no treatment are independent predictors of a higher HRQoL for PwH. CONCLUSION This study provides the first practical evidence of a significantly lower level of HRQoL in PwH than in the general population in China.
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Affiliation(s)
- Wenhui Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Shitong Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Feng Xue
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Lingling Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.,Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
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Newell P, Hirji S, Malarczyk A, Yazdchi F, Percy E, Harloff M, McGurk S, Shah P, Sabe A, Sobieszczyk P, Kaneko T. Marital Status and Sex-Based Differences in Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 173:106-111. [PMID: 35361479 DOI: 10.1016/j.amjcard.2022.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/01/2022]
Abstract
Studies have shown improved outcomes among married patients who underwent cardiovascular surgery; however, this has not been well studied in transcatheter aortic valve implantation (TAVi). We examined the impact of marital status and patient sex on outcomes after TAVi. Patients who underwent TAVi from January 2015 to June 2018 were reviewed and stratified into 3 groups: single, married, and widowed. The impact of marital status and sex on 30-day outcomes was assessed using a stepwise logistic regression analysis. Cumulative survival was estimated using Kaplan-Meier analysis and adjusted survival with multivariable Cox proportional hazards modeling. A total of 785 patients were included: 149 single, 413 married, and 223 widowed. Widowed patients were older (84 vs 79 years) with higher Society of Thoracic Surgeons risk scores (6.79% vs 5.51%, both p ≤0.001) than married patients. Neither marital status nor sex was associated with 30-day mortality or home discharge. However, 1-year survival revealed a differential survival penalty, with married females (p = 0.041) having lower survival and married males (p = 0.007) having higher survival than their single counterparts. This survival penalty persisted in the adjusted analyses (married females hazard ratio [HR] 2.24, p = 0.009; widowed males HR 2.42, p = 0.057). For patients who were readmitted in the first year, adjusted analysis showed widowed status was associated with higher 30-day readmissions (HR 1.91, p = 0.012) in both sexes. In conclusion, these findings suggest that marital status does not impact both sexes equally after TAVi; identifying at-risk patients and targeted interventions, such as adjusting discharge planning to ensure adequate home social support, may help improve outcomes.
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Henttunen R, Kohonen M, Laurikka J. Improved health-related quality of life in patients 6 and 12 months after surgical aortic valve replacement. SCAND CARDIOVASC J 2022; 56:121-126. [PMID: 35652506 DOI: 10.1080/14017431.2022.2079715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. Quality of life (QoL) is possibly the most important variable for the patient when subjective results of heart procedures are evaluated. The purpose of this study was to analyze the change in the quality of life 1 year after surgical aortic valve replacement (SAVR). Design. A Finnish single-center prospective cohort intervention study was performed from 2013 to 2018. QoL was assessed with the EQ-5D-3L VAS questionnaire before surgery and 6 and 12 months after surgery. We used univariate analysis to assess the change in the number of people experiencing problems and logistic regression analysis to assess the patients' characteristics on the change in QoL. Results. At one year follow-up, patients' quality of life improved in all EQ-5D dimensions. The greatest decreases in patients experiencing problems 12 months after surgery occurred in the dimension "mobility" (-24.1% change in reporting problems, p < .01), "self-care" (-32.9%, p < .01), and "pain or discomfort" (-25.7%, p < .01). Before surgery mean of EQ visual analogue scale (VAS, from 0 to 100) was 63.0 (SD 17.7, n = 604), and 12 months after surgery 81.2 (SD 13.8, n = 367, p < .001). In multivariable analysis, preoperative obesity was associated with better quality of life (OR 3.39, 95% CI 1.007-11.439) in "daily activities" and patients' higher operative risk was associated with better "self-care" after surgery. Conclusions. SAVR can improve the 1-year quality of life in all dimensions of EQ-5D and self-rated overall health (VAS).
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Affiliation(s)
- Riikka Henttunen
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Mika Kohonen
- Tampere University Hospital Heart Center, Tampere, Finland
| | - Jari Laurikka
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland.,Tampere University Hospital Heart Center, Tampere, Finland
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Sanders J, Bowden T, Woolfe-Loftus N, Sekhon M, Aitken LM. Predictors of health-related quality of life after cardiac surgery: a systematic review. Health Qual Life Outcomes 2022; 20:79. [PMID: 35585633 PMCID: PMC9118761 DOI: 10.1186/s12955-022-01980-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is important in determining surgical success, particularly from the patients' perspective. AIMS To identify predictors for HRQoL outcome after cardiac surgery in order to identify potentially modifiable factors where interventions to improve patient outcomes could be targeted. METHODS Electronic databases (including MEDLINE, CINAHL, Embase) were searched between January 2001 and December 2020 for studies determining predictors of HRQoL (using a recognised and validated tool) in adult patients undergoing cardiac surgery. Data extraction and quality assessments were undertaken and data was summarised using descriptive statistics and narrative synthesis, as appropriate. RESULTS Overall, 3924 papers were screened with 41 papers included in the review. Considerable methodological heterogeneity between studies was observed. Most were single-centre (75.6%) prospective observational studies (73.2%) conducted in patients undergoing coronary artery bypass graft (CABG) (n = 51.2%) using a version of the SF-36 (n = 63.4%). Overall, 103 independent predictors (62 pre-operative, five intra-operative and 36 post-operative) were identified, where 34 (33.0%) were reported in more than one study. Potential pre-operative modifiable predictors include alcohol use, BMI/weight, depression, pre-operative quality of life and smoking while in the post-operative period pain and strategies to reduce post-operative complications and intensive care and hospital length of stay are potential therapeutic targets. CONCLUSION Despite a lack of consistency across studies, several potentially modifiable predictors were identified that could be targeted in interventions to improve patient or treatment outcomes. This may contribute to delivering more person-centred care involving shared decision-making to improve patient HRQoL after cardiac surgery.
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Affiliation(s)
- Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7DN, UK.
- William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London, EC1M 6BQ, UK.
| | - Tracey Bowden
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Nicholas Woolfe-Loftus
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7DN, UK
| | - Mandeep Sekhon
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, 4111, Australia
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Arends BC, Blussé van Oud-Alblas HJ, Vernooij LM, Verwijmeren L, Biesma DH, Knibbe CAJ, Noordzij PG, van Dongen EPA. The association of polypharmacy with functional decline in elderly patients undergoing cardiac surgery. Br J Clin Pharmacol 2021; 88:2372-2379. [PMID: 34907549 DOI: 10.1111/bcp.15174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
AIM Identifying preoperative risk factors in older patients becomes more important to reduce adverse functional outcome. This study investigated the association between preoperative medication use and functional decline in elderly cardiac surgery patients and compared polypharmacy as a preoperative screening tool to a clinical frailty assessment. METHODS This sub-study of the Anaesthesia Geriatric Evaluation study included 518 patients ≥ 70 years undergoing elective cardiac surgery. The primary outcome was functional decline, defined as a worse health related quality of life or disability one year after surgery. The association between polypharmacy (i.e. ≥5 prescriptions and <10 prescriptions) or excessive polypharmacy (i.e. ≥10 prescriptions) and functional decline was investigated using multivariable Poisson regression. Discrimination, calibration and reclassification indices were used to compare preoperative screening tools for patient selection. RESULTS Functional decline was reported in 284 patients (55%) and preoperative polypharmacy and excessive polypharmacy showed higher risks (aRRs 1.57, 95% CI 1.23 - 1.98 and 1.93, 95% CI 1.48 - 2.50, respectively). Besides cardiovascular medication, proton pomp inhibitors and central nervous system medication were significantly associated with functional decline. Discrimination between models with polypharmacy or frailty was similar (AUC 0.67, 95% CI 0.61 - 0.72). The net reclassification index improved when including polypharmacy to the basic model (17%, 95% CI 0.06 - 0.27). CONCLUSIONS Polypharmacy is associated with functional decline in elderly cardiac surgery patients. A preoperative medication review is easily performed and could be used as screening tool to identify patients at risk for adverse outcome after cardiac surgery.
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Affiliation(s)
- Britta C Arends
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Lisette M Vernooij
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lisa Verwijmeren
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Douwe H Biesma
- Department of Internal Medicine, Leiden University Medical Centre, Leiden
| | - Catherijne A J Knibbe
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands.,Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden
| | - Peter G Noordzij
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Eric P A van Dongen
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
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[Quality of life in people with depression and physical comorbidity from a gender perspective]. Aten Primaria 2021; 53:101946. [PMID: 33431241 PMCID: PMC7910680 DOI: 10.1016/j.aprim.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of the study is to describe from a gender perspective how people with depression and physical comorbidity perceive their quality of life. The study included 380 people over 49 years of age with at least one of the following pathologies: diabetes, chronic obstructive pulmonary disease and ischemic heart disease. Participants were recruited from 31 teams the primary care of in Catalonia. Quality of life was measured using the EuroQol Scale. In addition, sociodemographic variables were collected, as well as the severity of depression, the index of economic deprivation and area of residence. The adjusted relationship between sex and dimensions of quality of life was assessed by means of multivariate logistic regression. RESULTS 81.3% were women; the mean age was 68.4 years (SD: 8.8). The mean on the Visual Analogue Scale was 57.8 (SD: 17.4) in men and 55.8 (SD: 18.6) in women. The mean of the EQ-Health Index was 0.74 (SD: 0.17) in men and 0.65 (SD: 0.2) in women (p = 0.001). The probability of having problems of the EQ-5D showed sex as the most important factor (woman = 1/man = 0) in: self-care OR: 2.29 (95% CI 1.04-5.07) and daily activities OR: 3.09 (95% CI 1.67-5.71). Mobility was associated with age OR: 1.87 (95% CI 1.22-2.86), pain with area of residence OR: 2.51 (95% CI 1.18-5,34) and the BDI with anxiety/depression OR: 4,77 (95% CI 1.77-12,88). CONCLUSION The perception quality of life of women with depression and physical comorbidity is lower than that of men and, in both cases, it is lower than that of the general population.
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12
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Curcio N, Bennett MM, Hebeler KR, Warren AM, Edgerton JR. Quality of Life Is Improved 1 Year After Cardiac Surgery. Ann Thorac Surg 2020; 111:1954-1960. [PMID: 33065050 DOI: 10.1016/j.athoracsur.2020.07.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/29/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Quality of life (QoL) is increasingly important in the era of patient-centered outcomes and value-based reimbursement. However most follow-up is limited to 30 days, and long-term data on QoL improvement associated with symptom relief are lacking. Therefore we sought to analyze QoL after cardiac surgery in a nonemergent, all-comers population. METHODS Four hundred two patients undergoing routine cardiac surgery at 2 large urban hospitals in the Dallas, Texas area were enrolled. Follow-up was complete for 364 patients. Data were collected from August 2013 to January 2017. The Kansas City Cardiomyopathy Questionnaire was administered at baseline, 1 month, and 1 year after surgery. Repeated-measures analysis was used for each domain of the questionnaire for all procedures and stratified by procedure. If time was found to be a significant factor, pairwise analysis was performed with P values adjusted using the Tukey-Kramer method. RESULTS There was a significant increase across all domains of Kansas City Cardiomyopathy Questionnaire scores for all procedures and for most domains when stratifying by procedure. This increase in QoL was most marked after 1 month. All domain scores increased through 1 year except symptom stability, which peaked at 1 month postsurgery and then regressed at 1 year, suggesting an overall improvement and stabilization of symptoms. The occurrence of complications did not alter this trajectory. CONCLUSIONS QoL and other patient-centered outcomes are improved at 1 month and continue to improve throughout the year. Knowledge of these data is important for patient selection, fully informed consent, and shared decision-making.
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Affiliation(s)
- Nicholas Curcio
- Division of Trauma, Critical Care and Acute Care Surgery, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
| | - Monica M Bennett
- Baylor Scott and White Research Institute, Baylor Scott & White Health, Dallas, Texas
| | - Katherine R Hebeler
- Baylor Scott and White Research Institute, Baylor Scott & White Health, Dallas, Texas
| | - Ann Marie Warren
- Division of Trauma, Critical Care and Acute Care Surgery, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas.
| | - James R Edgerton
- Baylor Scott and White Research Institute, Baylor Scott & White Health, Dallas, Texas; Division of Cardiothoracic Surgery, Washington University, Barnes Jewish Hospital, St Louis, Missouri; Department of Biology, College of Charleston, Charleston, South Carolina
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Callus E, Pagliuca S, Bertoldo EG, Fiolo V, Jackson AC, Boveri S, De Vincentiis C, Castelvecchio S, Volpe M, Menicanti L. The Monitoring of Psychosocial Factors During Hospitalization Before and After Cardiac Surgery Until Discharge From Cardiac Rehabilitation: A Research Protocol. Front Psychol 2020; 11:2202. [PMID: 33117210 PMCID: PMC7550819 DOI: 10.3389/fpsyg.2020.02202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/05/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction: There is considerable evidence that psychosocial factors contribute to the etiology and prognosis of cardiac illness. Currently, in Italy, psychologists are only obligatory in the cardiac rehabilitation setting, although there are indications that patients could be experiencing distress also during other moments of hospitalization, such as on admission for cardiac surgery. Objective and Methods: The objective of this protocol is to gain more information about cardiac patients, specifically during the various moments of hospitalization for cardiac surgery, by collecting data at admission before cardiac surgery (t0), at admission to cardiac rehabilitation (t1), and at discharge (t2) at the Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato hospital. A psychosocial questionnaire was constructed after consulting the relevant national and international guidelines. Patients admitted for cardiac surgery and attending a rehabilitation program will be evaluated by acquiring data about their civil status, religiosity, education and work capacity, social condition (including the presence and quality of intimate relationships and support received), previous psychological and psychiatric histories, psychological status, lifestyle (including questions on nutrition, smoking, alcohol, and substance abuse), adherence to therapy, quality of life (QoL), health perception, anxiety, and depression at t0. Health perception, anxiety, and depression are also measured at t1 and t2. Discussion and Conclusion: This study is an attempt to identify the recommended psychosocial variables which need to be monitored during cardiac patients' hospitalization for cardiac surgery, through to the completion of cardiac rehabilitation. After implementing this study at the IRCCS Policlinico San Donato, attempts will be made to create studies on a national and international level to generate more evidence regarding these variables, in order to create tailor-made interventions for these patients during these specific and delicate moments.
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Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Silvana Pagliuca
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Valentina Fiolo
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Carlo De Vincentiis
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Marianna Volpe
- Department of Cardiac Rehabilitation, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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14
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Nielsen S, Giang KW, Wallinder A, Rosengren A, Pivodic A, Jeppsson A, Karlsson M. Social Factors, Sex, and Mortality Risk After Coronary Artery Bypass Grafting: A Population-Based Cohort Study. J Am Heart Assoc 2020; 8:e011490. [PMID: 30852925 PMCID: PMC6475039 DOI: 10.1161/jaha.118.011490] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Little is known of the impact of social factors on mortality after coronary artery bypass grafting ( CABG ). We explored sex- and age-specific associations between mortality risk after CABG and marital status, income, and education. Methods and Results This population-based register study included 110 742 CABG patients (21.3% women) from the SWEDEHEART registry (Swedish Web-system for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies) operated 1992 to 2015. Cox regression models were used to study the relation between social factors and all-cause mortality. Never having been married compared with being married/cohabiting was associated with a higher risk in women than in men (hazard ratio 1.32, 95% CI 1.20-1.44) versus 1.17 (1.13-1.22), P=0.030 between sex. The lowest income quintile, compared with the highest, was associated with higher risk in men than in women (hazard ratio 1.44 [1.38-1.51] versus 1.25 [1.14-1.38], P=0.0036). Lowest education level was associated with higher risk without sex difference (hazard ratio 1.15 [1.11-1.19] versus 1.25 [1.16-1.35], P=0.75). For unmarried women aged 60 years at surgery with low income and low education, mortality 10 years after surgery was 18%, compared with 11% in married women with high income and higher education level. The median life expectancy was 4.8 years shorter. Corresponding figures for 60-year-old men were 21% versus 12% mortality risk at 10 years and 5.0 years shorter life expectancy. Conclusions There are strong associations between social factors and mortality risk after CABG in both men and women. These results emphasize the importance of developing and implementing secondary prevention strategies for CABG patients with disadvantages in social factors.
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Affiliation(s)
- Susanne Nielsen
- 1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | - Kok Wai Giang
- 1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | - Andreas Wallinder
- 2 Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Annika Rosengren
- 1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | | | - Anders Jeppsson
- 1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,2 Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Martin Karlsson
- 1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,4 Department of Medicine Skaraborg Hospital Lidköping Lidköping Sweden
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15
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Abstract
BACKGROUND Illness perception is composed of thoughts, ideas, and beliefs about illness, and a negative illness perception is known to be associated with poor outcomes. Among men and women, clinical outcomes after heart valve surgery are known to differ, but knowledge about differences in illness perception is sparse. OBJECTIVES The aim of this study is to describe the differences in illness perception among men and women after open heart valve surgery and to identify sociodemographic and clinical characteristics associated with worse illness perception in men and women. METHODS In a national cross-sectional study combined with register-based clinical and sociodemographic information, data on illness perception were collected with the Brief Illness Perception Questionnaire. Worse illness perception was defined as the worst quartile of each item of the Brief Illness Perception Questionnaire. Multiple logistic regression analyses were conducted to explore characteristics associated with worse illness perception. RESULTS Of 1084 eligible patients, 32% (n = 349) completed the questionnaire (67% men; mean age, 68 years). Compared with men, women reported significantly worse scores of illness perception in 6 of 8 items. Furthermore, being female, age, length of stay, and comorbidity were associated with worse illness perception (worse quartile of scores). Age, higher educational level, and comorbidity were found to be associated with worse illness perception for men and length of stay for women. CONCLUSION After open heart valve surgery, illness perception differs among men and women, with women having worse illness perception. Among the total population, being female, age, a longer length of stay, and comorbidity were also associated with worse illness perception.
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16
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Verwijmeren L, Peelen LM, van Klei WA, Daeter EJ, van Dongen EPA, Noordzij PG. Anaesthesia geriatric evaluation to guide patient selection for preoperative multidisciplinary team care in cardiac surgery. Br J Anaesth 2020; 124:377-385. [PMID: 32063340 DOI: 10.1016/j.bja.2019.12.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/20/2019] [Accepted: 12/24/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A multidisciplinary approach to improve postoperative outcomes in frail elderly patients is gaining interest. Multidisciplinary team care should be targeted at complex patients at high risk for adverse postoperative outcome to limit the strain on available resources and to prevent an unnecessary increase in patient burden. This study aimed to improve patient selection for multidisciplinary care by identifying risk factors for disability after cardiac surgery in elderly patients. METHODS This was a two-centre prospective cohort study of 537 patients aged ≥70 yr undergoing elective cardiac surgery. Before surgery, 11 frailty characteristics were investigated. Outcome was disability at 3 months defined as World Health Organization Disability Assessment Schedule 2.0 ≥25%. Multivariable modelling using logistic regression, concordance statistic (c-statistic), and net reclassification index was used to identify factors contributing to patient selection. RESULTS Disability occurred in 91 (17%) patients. Ten out of 11 frailty characteristics were associated with disability. A multivariable model, including the European System for Cardiac Operative Risk Evaluation II and preoperative haemoglobin, yielded a c-statistic of 0.71 (95% confidence interval [CI]: 0.66-0.77). After adding pre-specified frailty characteristics (polypharmacy, gait speed, physical disability, preoperative health-related quality of life, and living alone) to this model, the c-statistic improved to 0.78 (95% CI: 0.73-0.83). The net reclassification index was 0.32 (P<0.001), showing improved discrimination for patients at risk for disability at 3 months. CONCLUSIONS The addition of preoperative frailty characteristics to a multivariable model improved discrimination between elderly patients with and without disability at 3 months after cardiac surgery, and can be used to guide patient selection for preoperative multidisciplinary team care. CLINICAL TRIAL REGISTRATION NCT02535728.
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Affiliation(s)
- Lisa Verwijmeren
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Linda M Peelen
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, the Netherlands; Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wilton A van Klei
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Edgar J Daeter
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Eric P A van Dongen
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Peter G Noordzij
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, the Netherlands.
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17
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Kim HS, Kim Y, Kwon H. Health-related quality of life and readmission of patients with cardiovascular disease in South Korea. Perspect Public Health 2019; 141:28-36. [PMID: 31847706 DOI: 10.1177/1757913919892026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The purpose of this study was to investigate the health-related quality of life (HRQOL) of patients with cardiovascular disease and its relationship to hospital readmission. METHODS The cross-sectional study used data from 1037 adults aged ⩾19 years diagnosed with myocardial infarction or angina pectoris. Raw data were obtained from the fourth to sixth Korea National Health and Nutrition Examination Survey (2007-2014). RESULTS Readmission was found to be associated with age, living status, education level, unemployment, individual income level, stroke, osteoarthritis, diabetes, depression, low stress level, walking days per week, and activity limitations due to cardiovascular disease. CONCLUSION In summary, readmission was related to HRQOL among patients with myocardial infarction. Interventions that consider efforts to reduce readmission through improved diagnosis and development of systematic management of cardiovascular disease symptoms are required.
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Affiliation(s)
- Hyun Su Kim
- College of Nursing, Kyungdong University, Wonju, Republic of Korea
| | - Yoonjung Kim
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-Ro, Dongjack-Gu, Seoul 156-756, Republic of Korea
| | - Haejin Kwon
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
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18
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Bjørnnes AK, Lie I, Parry M, Falk R, Leegaard M, Rustøen T, Valeberg BT. Association between self-perceived pain sensitivity and pain intensity after cardiac surgery. J Pain Res 2018; 11:1425-1432. [PMID: 30122973 PMCID: PMC6078187 DOI: 10.2147/jpr.s167524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and purpose Cardiac surgical pain remains a clinical challenge affecting about 40% of individuals in the first six months post-cardiac surgery, and continues up to two years after surgery for about 15–20%. Self-perceived sensitivity to pain may help to identify individuals at risk for persistent cardiac surgical pain to optimize health care responses. The purpose of this study was to assess the relationship between self-perceived pain sensitivity assessed by the Pain Sensitivity Questionnaire (PSQ) and postoperative worst pain intensity up to 12 months after cardiac surgery. Sex differences in baseline characteristics and the PSQ scores were also assessed. Methods This study was performed among 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013. A secondary data-analysis was utilized to explore the relationship between preoperative PSQ scores and worst pain intensity rated preoperatively, across postoperative Days 1–4, at 2 weeks, and at 1, 3, 6, and 12 months post-surgery. Linear mixed model analyses were performed to estimate changes in pain intensity during 1-year follow-up. Results The mean (±standard deviation) PSQ-total score was 3.3±1.4, with similar scores in men and women. The PSQ-total score was significantly associated with higher worst pain intensity ratings adjusted for participant characteristics (p=0.001). Conclusion Use of the PSQ before surgery may predict cardiac surgical pain intensity. However, previous evidence is limited and not consistent, and more research is needed to substantiate our results.
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Affiliation(s)
- Ann Kristin Bjørnnes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway, .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada,
| | - Irene Lie
- Center for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada,
| | - Ragnhild Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Marit Leegaard
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Institute of Nursing, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway, .,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Berit Taraldsen Valeberg
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Institute of Nursing, Oslo, Norway
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