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Elgazzar SE, Qalawa SAA, Ali Hassan AM. Impact of educational programme on patient's health outcomes following open heart surgeries. Nurs Open 2022; 10:3028-3041. [PMID: 36480022 PMCID: PMC10077360 DOI: 10.1002/nop2.1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Postcardiac surgery, numerous factors have been shown to predict postoperative harm of QoL, such as age, female sex, history of hypertension, chronic obstructive pulmonary disease, education level, marital status, and also psychological factors such as the presence of mood disorders. So, the essential key to self-management is behavioural change, which is necessary to improve the quality of life of patients and Health outcomes. AIM The aim of this study is to evaluate the impact of the education programme on patients' health outcomes following open heart surgeries. PATIENTS AND METHODS Quasi-experimental research design carried out in intensive care for open heart surgery in Suez Canal university hospitals at Ismailia Governate on all available both sex patients performing open heart surgery for 6-month period (60) using the following four tools: the first tool for patient's risk stratification model Euro Scale sheet; the second tool New York Heart Association scale for assessing functional abilities; the third tool for health outcomes sheet for assessing patient's quality of life and health status; and the fourth tool for assessing Hospital Anxiety and Depression Scale. RESULTS There was no significant difference found in the patient's vital signs before and after the educational programme. On the other hand, there was no statistically significant difference between overall quality of life and socio-demographic characteristics before and after the educational programme. CONCLUSION This study concluded that the educational programme has a positive effect on patients' quality of life in patients' educational programme; improve patient's health status as indicated by improved patient outcomes. RELEVANCE TO CLINICAL PRACTICE The most important finding was the value of the educational training programme to address the needs of open heart surgery patients, indicating that after heart surgery, patient education by training can be helpful in self-care, and nurses can use a programme containing preparatory information to enhance results, alleviate patients problems, and improve the quality of life in patients with CABG.
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Affiliation(s)
- Samia Eaid Elgazzar
- Department of Medical‐Surgical Nursing, College of Nursing Qassim University Al Qassim Saudi Arabia
- Department of Medical‐Surgical Nursing, Faculty of Nursing Port‐Said University Port‐Said Egypt
| | - Shereen Ahmed Ahmed Qalawa
- Department of Medical‐Surgical Nursing, College of Nursing Qassim University Al Qassim Saudi Arabia
- Department of Medical‐Surgical Nursing, Faculty of Nursing Port‐Said University Port‐Said Egypt
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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] [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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Horn N, Laferton JAC, Shedden-Mora MC, Moosdorf R, Rief W, Salzmann S. Baseline depressive symptoms, personal control, and concern moderate the effects of preoperative psychological interventions: the randomized controlled PSY-HEART trial. J Behav Med 2022; 45:350-365. [PMID: 35522399 PMCID: PMC9160109 DOI: 10.1007/s10865-022-00319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/03/2022] [Indexed: 11/06/2022]
Abstract
This study examined whether baseline (3–14 days pre-surgery) levels of (i) depressive or (ii) anxiety symptoms and (iii) illness beliefs moderate the effects of additional preoperative interventions before coronary artery bypass graft surgery on (i) depressive or (ii) anxiety symptoms and (iii) illness beliefs 1 day before surgery, 1 week and 6 months after surgery. In the PSY-HEART trial, 115 patients were assessed. They were randomized into one of three groups: 1. receiving standard medical care only (SMC), additional psychological interventions: 2. aiming to optimize patients’ expectations (EXPECT), or 3. focusing on emotional support. Patients with a higher baseline level of depressive symptoms receiving a preoperative psychological intervention indicated lower depressive symptoms 6 months after surgery compared to SMC. EXPECT increased personal control and concern levels in patients with low baseline personal control/concern 1 day before surgery. Brief preoperative psychological interventions can improve psychological outcomes in heart surgery patients. Baseline status may moderate these effects. The study has been approved by the medical ethics committee of the Philipps University of Marburg and has been pre-registered at www.clinicaltrials.gov (NCT01407055) on August 1, 2011.
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Affiliation(s)
- Nicole Horn
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Johannes A C Laferton
- Division of Medical Psychology, Department of Medicine, Health and Medical University Potsdam, Potsdam, Germany
| | - Meike C Shedden-Mora
- Department of Psychology, Medical School Hamburg, Hamburg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Moosdorf
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Stefan Salzmann
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6523882. [DOI: 10.1093/ejcts/ezac041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
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Findakli F, Busse JW, Schemitsch EH, Lonn E, Farrokhyar F, Bhandari M. Smoking, Obesity, and Disability Benefits or Litigation Are Not Associated with Clinically Important Reductions in Physical Functioning After Intramedullary Nailing of Tibial Shaft Fractures: A Retrospective Cohort Study. Clin Orthop Relat Res 2021; 479:805-813. [PMID: 33196584 PMCID: PMC8083930 DOI: 10.1097/corr.0000000000001573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Forty percent of long bone fractures involve the tibia. These fractures are associated with prolonged recovery and may adversely affect patients' long-term physical functioning; however, there is limited evidence to inform what factors influence functional recovery in this patient population. QUESTION/PURPOSE In a secondary analysis of a previous randomized trial, we asked: What fracture-related, demographic, social, or rehabilitative factors were associated with physical function 1 year after reamed intramedullary nailing of open or closed tibial shaft fractures? METHODS This is a secondary (retrospective) analysis of a prior randomized trial (Trial to Re-evaluate Ultrasound in the Treatment of Tibial Fractures; TRUST trial). In the TRUST trial, 501 patients with unilateral open or closed tibial shaft fractures were randomized to self-administer daily low-intensity pulsed ultrasound or use a sham device, of which 15% (73 of 501) were not followed for 1 year due to early study termination as a result of futility (no difference between active and sham interventions). Of the remaining patients, 70% (299 of 428) provided full data. All fractures were fixed using reamed (298 of 299) or unreamed (1 of 299) intramedullary nailing. Thus, we excluded the sole fracture fixed using unreamed intramedullary nailing. The co-primary study outcomes of the TRUST trial were time to radiographic healing and SF-36 physical component summary (SF-36 PCS) scores at 1-year. SF-36 PCS scores range from 0 to 100, with higher scores being better, and the minimum clinically important difference (MCID) is 5 points. In this secondary analysis, based on clinical and biological rationale, we selected factors that may be associated with physical functioning as measured by SF-36 PCS scores. All selected factors were inserted simultaneously into a multivariate linear regression analysis. RESULTS After adjusting for potentially confounding factors, such as age, gender, and injury severity, we found that no factor showed an association that exceeded the MCID for physical functioning 1 year after intramedullary nailing for tibial shaft fractures. The independent variables associated with lower physical functioning were current smoking status (mean difference -3.0 [95% confidence interval -5 to -0.5]; p = 0.02), BMI > 30 kg/m2 (mean difference -3.0 [95% CI -5.0 to -0.3]; p = 0.03), and receipt of disability benefits or involvement in litigation, or plans to be (mean difference -3.0 [95% CI -5.0 to -1]; p = 0.007). Patients who were employed (mean difference 4.6 [95% CI 2.0 to 7]; p < 0.001) and those who were advised by their surgeon to partially or fully bear weight postoperatively (mean difference 2.0 [95% CI 0.1 to 4.0]; p = 0.04) were associated with higher physical functioning. Age, gender, fracture severity, and receipt of early physical therapy were not associated with physical functioning at 1-year following surgical fixation. CONCLUSION Among patients with tibial fractures, none of the factors we analyzed, including smoking status, receipt of disability benefits or involvement in litigation, or BMI, showed an association with physical functioning that exceeded the MCID. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Fawaz Findakli
- F. Findakli, J. W. Busse, F. Farrokhyar, M. Bhandari, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
- J. W. Busse, The Canadian Veterans Chronic Pain Centre of Excellence, Hamilton, ON, Canada
- E. H. Schemitsch, Department of Surgery, University of Western Ontario, London, ON, Canada
- E. Lonn, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- M. Bhandari, Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jason W Busse
- F. Findakli, J. W. Busse, F. Farrokhyar, M. Bhandari, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
- J. W. Busse, The Canadian Veterans Chronic Pain Centre of Excellence, Hamilton, ON, Canada
- E. H. Schemitsch, Department of Surgery, University of Western Ontario, London, ON, Canada
- E. Lonn, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- M. Bhandari, Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Emil H Schemitsch
- F. Findakli, J. W. Busse, F. Farrokhyar, M. Bhandari, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
- J. W. Busse, The Canadian Veterans Chronic Pain Centre of Excellence, Hamilton, ON, Canada
- E. H. Schemitsch, Department of Surgery, University of Western Ontario, London, ON, Canada
- E. Lonn, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- M. Bhandari, Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Eva Lonn
- F. Findakli, J. W. Busse, F. Farrokhyar, M. Bhandari, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
- J. W. Busse, The Canadian Veterans Chronic Pain Centre of Excellence, Hamilton, ON, Canada
- E. H. Schemitsch, Department of Surgery, University of Western Ontario, London, ON, Canada
- E. Lonn, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- M. Bhandari, Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Forough Farrokhyar
- F. Findakli, J. W. Busse, F. Farrokhyar, M. Bhandari, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
- J. W. Busse, The Canadian Veterans Chronic Pain Centre of Excellence, Hamilton, ON, Canada
- E. H. Schemitsch, Department of Surgery, University of Western Ontario, London, ON, Canada
- E. Lonn, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- M. Bhandari, Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- F. Findakli, J. W. Busse, F. Farrokhyar, M. Bhandari, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- J. W. Busse, Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
- J. W. Busse, The Canadian Veterans Chronic Pain Centre of Excellence, Hamilton, ON, Canada
- E. H. Schemitsch, Department of Surgery, University of Western Ontario, London, ON, Canada
- E. Lonn, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- M. Bhandari, Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Quality of Life After Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228439. [PMID: 33202650 PMCID: PMC7697861 DOI: 10.3390/ijerph17228439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 12/31/2022]
Abstract
Coronary heart disease is a public health problem and is one of the leading causes of loss of quality of life, disability, and death worldwide. The main procedure these patients undergo is cardiac catheterisation, which helps improve their quality of life, symptoms of myocardial ischemia, and ventricular function, thus helping increase the survival rate of sufferers. It can also, however, lead to physical consequences, including kidney failure, acute myocardial infarction, and stroke. The objective of this study was to analyse how coronary artery bypass grafting (CABG) influences quality of life. A systematic review and meta-analysis were conducted using the CINAHL, PubMed, Scopus, and Cuiden databases in June 2020. A total of 7537 subjects were included, 16 in the systematic review and 3 in the meta-analysis. The studies analysing quality of life using the SF questionnaire showed improvements in the quality of physical and mental appearance, and those using the NHP questionnaire showed score improvements and, in some cases, differences in quality of life between women and men. This operation seems to be a good choice for improving the quality of life of people with coronary pathologies, once the possible existing risks have been assessed.
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Abdallah M, Mamdouh S, El-Gilany AH, Abdel-Aziz W, Farag O, ElAdawy N. Short-term outcomes of surgical myocardial revascularization on health-related quality of life: a validation of the Arabic MacNew heart disease questionnaire. THE CARDIOTHORACIC SURGEON 2020. [DOI: 10.1186/s43057-020-00028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Impaired quality of life (QOL) is common in coronary heart disease and is the major indications for coronary artery bypass graft (CABG) operations. This study aims to compare the QOL of patients with coronary heart disease before and after CABG surgery.
Results
A translated Arabic version of the Mac-New health-related QOL questionnaire was used to evaluate QOL improvement in 446 patients who benefited from elective CABG at Nasser Institute for Research and Treatment. There was a statistically significant improvement in physical, emotional, social, and global domains of QOL, as evaluated 3 and 6 months after surgery. Follow-up was 90.4% complete. At 3 months, multiple linear regression has shown that male patients (β = 0.48, p ≤ 0.001) and rural residence (β = 0.39, p ≤ 0.001) were significant independent predictors of improvement in physical QOL domain. While hypercholesterolemia (β = −0.20, −0.49, −0.37, −0.46, p ≤ 0.001), hypertension (β = −0.29, −0.39, p ≤ 0.001, β = −0.35, −β = 0.35, p = 0.001), and smoking (β = −0.79, p ≤ 0.001, β = −0.33, p = 0.04, β = −0.69, p ≤ 0.001, β = −0.47, p = 0.005) were significant predictors of worsening in physical, emotional, social, and global domains, respectively. At 6 months, low preoperative ejection fraction (EF) ≤ 40% was the strongest predictor of improvement (β = 0.54, 0.49, 0.44, and 0.52, p ≤ 0.001) in physical, emotional, social, and global domains of QOL, respectively. But, peripheral vascular disease (PVD) (β = −0.53, p = 0.05, β = −0.81, p = 0.005, β = −0.62, p = 0.03, β = −0.76, p = 0.008) and smoking (β = −0.53, p = 0.001, β = −0.42, p = 0.01, β = −0.42, p = 0.01, β = −0.41, p = 0.02) were significant predictors of worsening in physical, emotional, social, and global domains of QOL, respectively.
Conclusions
CABG surgery improved in all domains of QOL. Further studies are required to evaluate changes in QOL at longer period intervals.
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Pačarić S, Turk T, Erić I, Orkić Ž, Petek Erić A, Milostić-Srb A, Farčić N, Barać I, Nemčić A. Assessment of the Quality of Life in Patients before and after Coronary Artery Bypass Grafting (CABG): A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041417. [PMID: 32098322 PMCID: PMC7068373 DOI: 10.3390/ijerph17041417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 01/21/2023]
Abstract
The aim of this study was to examine the quality of life and to report on the utility and QALY measures in patients before and after coronary artery bypass grafting (CABG); to investigate whether the SF-12 is comparable with the SF-36 for measuring health-related quality of life of patients with CABG; and to determine the impact of individual predictors on poor quality of life assessment after rehabilitation. This prospective study was conducted between January 2017 and December 2018 at the University Hospital Center Osijek, at three time points: pre-operation, 1 month after surgery, and after rehabilitation. The study was conducted with the SF-36 and SF-12 health questionnaires on 47 participants. After rehabilitation, there was a significant improvement in all domains of quality of life. The highest score was given to the change in pain (BP); mean scores were 63.8 (95% CI 56.9 to 70.6) (p = 0.001). The lowest grade (the lowest quality) after rehabilitation was in the domain of limitations due to physical difficulties (RP); arithmetic mean was 48.5 (95% CI 41 to 55.9) (p < 0.001). Quality-adjusted life-year was 0.41 (95% CI 0.38–0.44) after the CABG. The results of this study show that patients with coronary heart disease have poor quality of life before surgery. One month after the surgery, the quality of life improved, but was still inadequate. One year after surgery, satisfactory results were obtained in almost all subscales. The SF-36, SF-12, and its components, can be used effectively in patients with CABG. Age, gender, lifestyle, and risk factors in our sample of participants are not predictors of poor quality of life assessment after rehabilitation.
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Affiliation(s)
- Stana Pačarić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Tajana Turk
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
| | - Ivan Erić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
| | - Želimir Orkić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
| | - Anamarija Petek Erić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Andrea Milostić-Srb
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Nikolina Farčić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
- Correspondence: ; Tel.: +385-98-186-85-69
| | - Ivana Barać
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31 000, Croatia; (A.M.-S.); (I.B.)
| | - Ana Nemčić
- University Hospital Centre Osijek, Osijek 31 000, Croatia; (S.P.); (T.T.); (I.E.); (Ž.O.); (A.P.E.); (A.N.)
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Coelho PNMP, Miranda LMRPC, Barros PMP, Fragata JIG. Quality of life after elective cardiac surgery in elderly patients. Interact Cardiovasc Thorac Surg 2019; 28:199-205. [PMID: 30085061 DOI: 10.1093/icvts/ivy235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/15/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Cardiac surgery has little effect on life expectancy in elderly patients. Thus, improving the quality of life should be the main factor affecting therapeutic decisions. Most studies on quality of life in elderly patients undergoing cardiac surgery report improvement but have limitations. Consequently, we assessed improvements in the quality of life of elderly patients undergoing elective cardiac surgery, identified influencing variables and established patterns of mental and physical health variations in the first year postoperatively. METHODS We conducted a prospective study of patients aged 65 or older who underwent elective cardiac surgery between September 2011 and August 2013. The 36-item Short Form (SF-36) surveys were obtained preoperatively and at 3, 6 and 12 months postoperatively. RESULTS The 430 preoperative patients with a mean age of 74 years (SD 5.5 years) comprised 220 men. Most physical health improvements occurred within 3 months and continued to improve significantly until 12 months. Predictive variables for patients showing less improvement were poor preoperative physical health, female sex, older age and longer length of hospital stay. Mental health improved significantly through the third postoperative month. The negative predictive variables were poor preoperative mental health and longer intensive care unit stay. CONCLUSIONS Most patients improved both physically and mentally after surgery, and most of the improvement occurred within 3 months post-surgery. These improvement patterns should be taken into account when creating rehabilitation programmes, and patients should be counselled on what improvements can be expected during the first 12 months after surgery.
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Affiliation(s)
- Pedro N M P Coelho
- Department of Cardiothoracic Surgery, Hospital Santa Marta, Lisbon, Portugal.,Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | - José I G Fragata
- Department of Cardiothoracic Surgery, Hospital Santa Marta, Lisbon, Portugal.,Universidade Nova de Lisboa, Lisbon, Portugal
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Perrotti A, Ecarnot F, Monaco F, Dorigo E, Monteleone P, Besch G, Chocron S. Quality of life 10 years after cardiac surgery in adults: a long-term follow-up study. Health Qual Life Outcomes 2019; 17:88. [PMID: 31118026 PMCID: PMC6532216 DOI: 10.1186/s12955-019-1160-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background Quality of life (QoL) is a multifactorial concept that assesses physical and mental health. We prospectively studied the quality of life of patients undergoing coronary artery bypass graft (CABG) surgery using the Short-Form 36-item questionnaire (SF-36) up to 10 years after surgery. Methods Between January 2000 and December 2002, all patients undergoing elective isolated CABG in the cardiac & thoracic surgery department of a large university hospital in Eastern France underwent initial QoL evaluation with the SF-36. The same questionnaire was mailed to every patient annually (± 2 weeks around the date of surgery) up to 10 years after their operation. We recorded socio-demographic and clinical variables at inclusion. Predictors of impaired QoL at 10 years were identified by logistic regression. Results A total of 272 patients (213 men, 59 women) were enrolled; mean age at inclusion was 65 ± 10 years. At 10 years post-surgery, 81 patients had died (29.7%). The physical component summary (PCS) score was significantly higher at 5 years after surgery than at baseline (p < 0.01), and significantly lower at 10 years than at 5 years (p < 0.01), although there remained a significant difference between 10-year PCS and baseline score (p = 0.004). The mental component summary (MCS) score was significantly higher at 5 years than at the time of surgery (p < 0.001), and remained significantly higher compared to baseline at 10 years after surgery (p = 0.010). By multivariate analysis, diabetes and dypsnea were both associated with worse PCS at 10 years, while lower age was associated with better 10-year PCS. Only diabetes was associated with impaired MCS at 10 years. Conclusions Cardiac surgery appears to durably and positively affect both physical and mental components of quality of life. Electronic supplementary material The online version of this article (10.1186/s12955-019-1160-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Perrotti
- Cardio-Thoracic Surgery Department, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besançon, France.,EA 3920, University of Franche-Comté, 25000, Besançon, France
| | - Fiona Ecarnot
- EA 3920, University of Franche-Comté, 25000, Besançon, France. .,Department of Cardiology, University Hospital Jean Minjoz, 3, Boulevard Fleming, 25000, Besançon, France.
| | - Francesco Monaco
- Cardio-Thoracic Surgery Department, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besançon, France.,Department of Mental Health, Residential Eating Disorder Unit "Mariconda", ASL Salerno, Salerno, Italy
| | - Enrica Dorigo
- Cardio-Thoracic Surgery Department, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besançon, France
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Guillaume Besch
- EA 3920, University of Franche-Comté, 25000, Besançon, France.,Department of Anesthesiology and Surgical Intensive Care Unit, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besançon, France
| | - Sidney Chocron
- Cardio-Thoracic Surgery Department, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besançon, France.,EA 3920, University of Franche-Comté, 25000, Besançon, France
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11
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Evaluating Perceptions of Self-efficacy and Quality of Life in Patients Having Coronary Artery Bypass Grafting and Their Family Caregivers. J Cardiovasc Nurs 2018; 34:250-257. [PMID: 30489417 DOI: 10.1097/jcn.0000000000000553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Self-efficacy is a critical factor for quality of life in patients who undergo coronary artery bypass grafting, as well as for their family caregivers. However, there is lack of knowledge about whether patients' self-efficacy and caregivers' perceptions of patient self-efficacy are associated with quality of life in patient and caregiver dyads. OBJECTIVES The aims of this study were to compare self-efficacy and quality of life between patients and family caregivers and to examine whether patients' and caregivers' perceptions of patient self-efficacy were associated with their own and their partner's quality of life in patient and caregiver dyads who were waiting for patients' coronary artery bypass grafting. METHODS In this cross-sectional study, 84 dyads (85% male patients and 87% female caregivers) completed the Cardiac Self-efficacy Scale, which consists of self-efficacy for controlling symptoms and self-efficacy for maintaining function subscales, and the Short-Form 12 Health Survey for quality of life. Data were analyzed using the Actor-Partner Interdependence Model. RESULTS Caregivers rated patient self-efficacy for maintaining function higher than did patients themselves and caregivers' perceptions were positively correlated with patients' physical health. Patients' self-efficacy for maintaining function exhibited an actor effect on their own mental health. There were no other actor or partner effects of self-efficacy on quality of life. CONCLUSIONS Differences between patients' and caregivers' perceptions of patient self-efficacy for maintaining function should be addressed before surgery to reduce discordance. Patients' self-efficacy for maintaining function was associated with their own quality of life. There was no partner (relationship) effect of self-efficacy on quality of life. More research is needed in this area.
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12
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Grand N, Bouchet JB, Zufferey P, Beraud AM, Awad S, Sandri F, Campisi S, Fuzellier JF, Molliex S, Vola M, Morel J. Quality of Life After Cardiac Operations Based on the Minimal Clinically Important Difference Concept. Ann Thorac Surg 2018; 106:548-554. [PMID: 29580777 DOI: 10.1016/j.athoracsur.2018.02.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 02/07/2018] [Accepted: 02/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is an increasingly important issue in assessing the consequences of any surgical or medical intervention. Our study aimed to evaluate change in HRQOL 6 months after elective cardiac operations and to identify specific predictors of poor HRQOL. METHODS In this prospective, single-center study, HRQOL was evaluated before and 6 months after the operation using the Medical Outcome Study 36-Item Short Form Health Survey questionnaire and its two components: the Physical Component Summary and the Mental Component Summary. We distinguished patients with worsening of HRQOL according to the minimal clinically important difference. All consecutive adult patients undergoing cardiac operations were included. RESULTS The preoperative and postoperative 36-Item Short Form Health Survey questionnaires were completed by 326 patients, and 24 patients died before completing follow-up questionnaires. On the basis of the definition used, clinically significant deterioration of HRQOL was observed in 93 patients (26.6%) for the Physical Component Summary and in 99 patients (28.2%) for the Mental Component Summary. Renal replacement for acute renal failure and mechanical ventilation for longer than 48 hours were independent risk factors for Physical Component Summary and Mental Component Summary worsening or death. CONCLUSIONS Although our study showed overall improvement of quality of life after cardiac operations, more than one-quarter of the patients manifested deterioration of HRQOL at 6 months postoperatively. The findings from this study should help clinicians to inform patients about their likely postoperative functional status and quality of life.
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Affiliation(s)
- Nathalie Grand
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Jean Baptiste Bouchet
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Paul Zufferey
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Anne Marie Beraud
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Sahar Awad
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Fabricio Sandri
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Salvator Campisi
- Department of Cardiac Surgery, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Jean François Fuzellier
- Department of Cardiac Surgery, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Serge Molliex
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Marco Vola
- Department of Cardiac Surgery, Saint Etienne University Teaching Hospital, Saint Etienne, France
| | - Jerome Morel
- Department of Anesthesia and Intensive Care Medicine, Saint Etienne University Teaching Hospital, Saint Etienne, France.
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13
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Stoicea N, You T, Eiterman A, Hartwell C, Davila V, Marjoribanks S, Florescu C, Bergese SD, Rogers B. Perspectives of Post-Acute Transition of Care for Cardiac Surgery Patients. Front Cardiovasc Med 2017; 4:70. [PMID: 29230400 PMCID: PMC5712014 DOI: 10.3389/fcvm.2017.00070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/25/2017] [Indexed: 12/20/2022] Open
Abstract
Post-acute care (PAC) facilities improve patient recovery, as measured by activities of daily living, rehabilitation, hospital readmission, and survival rates. Seamless transitions between discharge and PAC settings continue to be challenges that hamper patient outcomes, specifically problems with effective communication and coordination between hospitals and PAC facilities at patient discharge, patient adherence and access to cardiac rehabilitation (CR) services, caregiver burden, and the financial impact of care. The objective of this review is to examine existing models of cardiac transitional care, identify major challenges and social factors that affect PAC, and analyze the impact of current transitional care efforts and strategies implemented to improve health outcomes in this patient population. We intend to discuss successful methods to address the following aspects: hospital-PAC linkages, improved discharge planning, caregiver burden, and CR access and utilization through patient-centered programs. Regular home visits by healthcare providers result in decreased hospital readmission rates for patients utilizing home healthcare while improved hospital-PAC linkages reduced hospital readmissions by 25%. We conclude that widespread adoption of improvements in transitional care will play a key role in patient recovery and decrease hospital readmission, morbidity, and mortality.
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Affiliation(s)
- Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tian You
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Andrew Eiterman
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Clifton Hartwell
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Victor Davila
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephen Marjoribanks
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Sergio Daniel Bergese
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Barbara Rogers
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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14
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Mahdizadeh M, Alavi M, Ghazavi Z. The effect of education based on the main concepts of logotherapy approach on the quality of life in patients after coronary artery bypass grafting surgery. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:14-9. [PMID: 26985218 PMCID: PMC4776556 DOI: 10.4103/1735-9066.174752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Improving the patients’ quality of life (QOL) after coronary artery bypass grafting (CABG) is one of the main concerns of the treatment team. Educational interventions may affect the aspects of QOL in various ways. The present study aimed to investigate the effect of education based on the main concepts of logotherapy approach on the CABG patients’ quality of life. Materials and Methods: In this quasi-experimental study, a convenient sample of 67 patients who had undergone CABG in Isfahan Chamran hospital were randomly allocated to two groups of experimental (n = 35) and control (n = 32). While the control group received routine care, the experiment group benefitted from logotherapy-based education program (six 90-min sessions, twice a week). SF-36 questionnaire was completed by both two groups (before and 1 month after intervention). Descriptive and inferential statistical tests (consisting of independent t-test) were employed to analyze data in SPSS version 13. Results: The pre-test mean total score of SF-36 questionnaire and also the mean scores of its eight dimensions were not significantly different between the two groups. The post-test mean score change [Standard Error (SE)] in the intervention group was 24.95 (3) and in the control group was 9.27 (0.82). There were significant differences between the two groups (P < 0.001). Moreover, the mean scores of six dimensions of QOL (vitality, bodily pain, general health, emotional role, social functioning, and mental health) changed significantly in the intervention group. Conclusions: Our findings indicated that the intervention has improved the patients’ QOL after CABG. Integration of such an intervention in these patients’ rehabilitation programs is recommended.
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Affiliation(s)
- Mostafa Mahdizadeh
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mousa Alavi
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Ghazavi
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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15
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Predictors of subjective health status 10 years post-PCI. IJC HEART & VASCULATURE 2016; 11:19-23. [PMID: 28616521 PMCID: PMC5441316 DOI: 10.1016/j.ijcha.2016.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 01/21/2016] [Accepted: 03/07/2016] [Indexed: 12/31/2022]
Abstract
Background Subjective health status is an increasingly important parameter to assess the effect of percutaneous coronary intervention (PCI) in clinical practice. Aim of this study was to determine medical and psychosocial predictors of poor subjective health status over a 10 years' post-PCI period. Methods We included a series of consecutive PCI patients (n = 573) as part of the RESEARCH registry, a Dutch single-center retrospective cohort study. Results These patients completed the 36-item Short-Form Health Survey (SF-36) at baseline and 10 years post-PCI. We found 6 predictors of poor subjective health status 10 years post-PCI: SF-36 at baseline, age, previous PCI, obesity, acute myocardial infarction as indication for PCI, and diabetes mellitus (arranged from most to least numbers of sub domains). Conclusions SF-36 scores at baseline, age, and previous PCI were significant predictors of subjective health status 10 years post-PCI. Specifically, the SF-36 score at baseline was an important predictor. Thus assessment of subjective health status at baseline is useful as an indicator to predict long-term subjective health status. Subjective health status becomes better by optimal medical treatment, cardiac rehabilitation and psychosocial support. This is the first study determining predictors of subjective health status 10 years post-PCI.
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16
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Fakhrzad N, Goudarzi R, Barouni M, Kojuri J, Jahani Y. Examining the Health-Related Quality of Life after Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Iran via SF-36 and SAQ. Int Cardiovasc Res J 2015. [DOI: 10.17795/icrj-10(03)123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Lankarani MM, Assari S. Association between number of comorbid medical conditions and depression among individuals with diabetes; race and ethnic variations. J Diabetes Metab Disord 2015; 14:56. [PMID: 26161363 PMCID: PMC4496852 DOI: 10.1186/s40200-015-0171-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/10/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Medical and psychiatric comorbidities are commonly comorbid with diabetes. Race and ethnicity may, however, modify the link between medical and psychiatric comorbidities in individuals with diabetes. In this study we compared Non-Hispanic Whites, African Americans, and Caribbean Blacks with diabetes for the association between number of comorbid medical conditions and lifetime and 12-month major depressive disorder (MDD) in individuals with diabetes. METHODS Data came from the National Survey of American Life (NSAL), 2001-2003. We included 603 patients with diabetes (75 non-Hispanic Whites, 396 African Americans, and 131 Caribbean Blacks). Number of comorbid medical conditions was the independent variable, lifetime and 12-month MDD were dependent variables, and age, gender, education, marital status, employment, and body mass index were covariates. Race- and ethnic- specific logistic regressions were used to determine race and ethnic differences in the associations between number of chronic medical conditions and lifetime and 12-month MDD, while the effect of all covariates were controlled. RESULTS Number of chronic medical conditions was positively associated with lifetime MDD among non-Hispanic Whites (OR = 1.719, 95 % CI = 1.018 - 2.902) and African Americans (OR = 1.235, 95 % CI = 1.056- 1.445) but not Caribbean Blacks (P > .05). Number of chronic medical conditions was also associated with 12-month MDD among non-Hispanic Whites (OR = 1.757, 95 % CI = 1.119 - 2.759) and African Americans (OR = 1.381, 95 % CI = 1.175 - 1.623) but not Caribbean Blacks (P > .05). CONCLUSIONS This study shows race- and ethnic- differences in the association between number of medical comorbidities and MDD among patients with diabetes. These findings invite researchers to study the mechanisms behind race- and ethnic- differences in vulnerability and resilience to the mental health effects of chronic medical conditions.
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Affiliation(s)
- Maryam Moghani Lankarani
- />Department of Psychiatry, School of Medicine, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109-2700 USA
- />Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
| | - Shervin Assari
- />Department of Psychiatry, School of Medicine, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109-2700 USA
- />Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
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18
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Vincelj J, Bitar L, Jendričko T, Udovičić M, Petrovečki M. Health-related quality of life five years after coronary artery bypass graft surgery. Int J Cardiol 2014; 182:68-9. [PMID: 25576722 DOI: 10.1016/j.ijcard.2014.12.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/25/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Josip Vincelj
- Institute of Cardiovascular Diseases, Dubrava University Hospital, Zagreb, Croatia; University of Applied Health Studies, Zagreb, Croatia.
| | - Lela Bitar
- Clinic for Pulmonary Diseases, University Hospital Center Zagreb, Zagreb, Croatia
| | - Tihana Jendričko
- Department of Psychiatry, University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Mario Udovičić
- Institute of Cardiovascular Diseases, Dubrava University Hospital, Zagreb, Croatia
| | - Mladen Petrovečki
- Laboratory Diagnostics, Dubrava University Hospital, Zagreb, Croatia
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19
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Gaulin C, Sebaratnam DF, Fernández-Peñas P. Quality of life in non-melanoma skin cancer. Australas J Dermatol 2014; 56:70-6. [DOI: 10.1111/ajd.12205] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 05/19/2014] [Indexed: 11/26/2022]
Affiliation(s)
| | - Deshan F Sebaratnam
- University of Sydney; Sydney New South Wales Australia
- Department of Dermatology; Westmead Hospital; Sydney New South Wales Australia
- Skin and Cancer Foundation Australia; Sydney New South Wales Australia
| | - Pablo Fernández-Peñas
- University of Sydney; Sydney New South Wales Australia
- Department of Dermatology; Westmead Hospital; Sydney New South Wales Australia
- Skin and Cancer Foundation Australia; Sydney New South Wales Australia
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20
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Maddox TM, Ho PM, Rumsfeld JS. Health-related quality-of-life outcomes among coronary artery bypass graft surgery patients. Expert Rev Pharmacoecon Outcomes Res 2014; 7:365-72. [DOI: 10.1586/14737167.7.4.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Assari S, Moghani Lankarani M, Ahmadi K. Comorbidity influences multiple aspects of well-being of patients with ischemic heart disease. Int Cardiovasc Res J 2013; 7:118-23. [PMID: 24757635 PMCID: PMC3987444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/03/2013] [Accepted: 10/28/2013] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Comorbidity is prevalent among patients with Ischemic Heart Disease (IHD) and may influence patients' subjective and objective domains of well-being. OBJECTIVES We aimed to investigate the associations between comorbidity and different measures of well-being (i.e. health related quality of life, psychological distress, sleep quality, and dyadic adjustment) among patients with IHD. METHODS In this cross-sectional study, 796 outpatients with documented IHD were enrolled from an outpatient cardiology clinic in 2006. Comorbidity (Ifudu index), quality of life (SF36), psychological distress (Hospital Anxiety Depression Scale; HADS), sleep quality (Pittsburg Sleep Quality Index; PSQI), and dyadic adjustment quality (Revised Dyadic Adjustment Scale; RDAS) were measured. Associations between comorbidity and different measures of well-being were determined. RESULTS Significant correlations were found between comorbidity score and all measures of well-being. Comorbidity score was correlated with physical quality of life (r = -0.471, P < 0.001), mental quality of life (r = -0.447, P < 0.001), psychological distress (r = 0.344, P < 0.001), sleep quality (r = 0.358, P < 0.001), and dyadic adjustment (r = -0.201, P < 0.001). CONCLUSIONS This study showed a consistent pattern of associations between somatic comorbidities and multiple aspects of well-being among patients with IHD. Findings may increase cardiologists' interest to identify and treat somatic conditions among IHD patients.
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Affiliation(s)
- Shervin Assari
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA,Center for Research on Ethnicity, Culture, and Health (CRECH), School of PublicHealth, University of Michigan, Ann Arbor, Michigan, USA,Corresponding author: Shervin Assari, Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, Washington Heights 1415, Michigan, USA, P.O. Box: 48109-2029.Tel: +1-7347649494, Fax: 1-7347637379, E-mail:
| | - Maryam Moghani Lankarani
- Medicine and Health Promotion Institute, Tehran, IR Iran,Universal Network for Health Information Dissemination and Exchange (UNHIDE), Tehran, IR Iran
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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22
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Thomson P, Niven CA, Peck DF, Eaves J. Patients' and partners' health-related quality of life before and 4 months after coronary artery bypass grafting surgery. BMC Nurs 2013; 12:16. [PMID: 23829859 PMCID: PMC3744164 DOI: 10.1186/1472-6955-12-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 07/03/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients having coronary artery bypass grafting (CABG) often depend on their partners for assistance before and after surgery. Whilst patients' physical and mental health usually improves after surgery little is known about the partners' health-related quality of life (HRQoL) in CABG. If the partners' physical and emotional health is poor this can influence their caregiving role and ability to support the patient. This study aimed: to increase understanding of patients' and partners' HRQoL before and after CABG; to explore whether patients' and partners' pre-operative socio-demographics and HRQoL predict their own, and also partners' HRQoL 4 months after CABG. METHODS This prospective study recruited 84 dyads (patients 84% males, aged 64.5 years; partners 94% females, aged 61.05 years). Patients' and partners' perceived health status was assessed using the Short-Form 12 Health Survey. Patients' physical limitation, angina symptoms and treatment satisfaction were assessed using the Seattle Angina Questionnaire. Partners' emotional, physical and social functioning was assessed using the Quality of Life of Cardiac Spouses Questionnaire. Data were analysed using hierarchical multiple (logistic) regressions, repeated measures analysis of variance, paired t test and Chi square. RESULTS Patients most likely to have poorer physical health post-operatively were associated with partners who had poorer pre-operative physical health. Partners most likely to have poorer emotional, physical and social functioning post-operatively were associated with patients who had poorer pre-operative mental health. Patients" and partners' poorer post-operative HRQoL was also explained by their poorer pre-operative HRQoL. CONCLUSION The partners' involvement should be considered as part of patients' pre-operative assessment. Special attention needs be paid to patients' pre-operative mental health since it is likely to impact on their post-operative mental health and the partner's emotional, physical and social functioning.
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Affiliation(s)
- Patricia Thomson
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
| | - Catherine A Niven
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
| | - David F Peck
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
| | - Jennifer Eaves
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
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Bramer S, ter Woorst FJ, van Geldorp MW, van den Broek KC, Maessen JG, Berreklouw E, van Straten AH. Does new-onset postoperative atrial fibrillation after coronary artery bypass grafting affect postoperative quality of life? J Thorac Cardiovasc Surg 2013; 146:114-8. [DOI: 10.1016/j.jtcvs.2012.06.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/14/2012] [Accepted: 06/15/2012] [Indexed: 11/29/2022]
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24
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Wang W, Thompson DR, Ski CF, Liu M. Health-related quality of life and its associated factors in Chinese myocardial infarction patients. Eur J Prev Cardiol 2012; 21:321-9. [PMID: 22767965 DOI: 10.1177/2047487312454757] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Healthcare providers are called on to assess and improve the health-related quality of life (HRQL) of patients with myocardial infarction (MI). However, there is lack of empirical data on HRQL of such individuals in mainland China. The purpose of this study is to assess HRQL and identify associated factors in hospitalized Chinese MI patients. METHODS A single group, cross-sectional design was adopted with a sample of 192 hospitalized MI patients at two teaching hospitals in Xi'an, People's Republic of China. HRQL was assessed using the Chinese Mandarin versions of the Short Form 36 health survey (SF-36), the Myocardial Infarction Dimensional Assessment Scale (MIDAS), and the Hospital Anxiety and Depression Scale (HADS). RESULTS Chinese MI patients reported poor HRQL as measured by both the generic (SF-36) and disease-specific (MIDAS) instruments. Advancing age and the presence of heart failure, anxiety, and depression were significant predictors of overall HRQL. Smoking and hypertension were significant predictors of the physical aspects of HRQL. CONCLUSIONS Assessing HRQL of hospitalized Chinese MI patients and identifying associated factors may help health professionals in the design and delivery of appropriately tailored and culturally relevant interventions to this group of patients.
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Affiliation(s)
- Wenru Wang
- National University of Singapore, Singapore
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Tindle H, Belnap BH, Hum B, Houck PR, Mazumdar S, Scheier MF, Matthews KA, He F, Rollman BL. Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery. Psychosom Med 2012; 74:200-7. [PMID: 22286847 PMCID: PMC4056336 DOI: 10.1097/psy.0b013e318244903f] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Optimism has been associated with a lower risk of rehospitalization after coronary artery bypass graft (CABG) surgery, but little is known about how optimism affects treatment of depression in post-CABG patients. METHODS Using data from a collaborative care intervention trial for post-CABG depression, we conducted exploratory post hoc analyses of 284 depressed post-CABG patients (2-week posthospitalization score in the 9-item Patient Health Questionnaire ≥ 10) and 146 controls without depression who completed the Life Orientation Test - Revised (full scale and subscale) to assess dispositional optimism. We classified patients as optimists and pessimists based on the sample-specific Life Orientation Test - Revised distributions in each cohort (full sample, depressed, nondepressed). For 8 months, we assessed health-related quality of life (using the 36-item Short-Form Health Survey) and mood symptoms (using the Hamilton Rating Scale for Depression [HRS-D]) and adjudicated all-cause rehospitalization. We defined treatment response as a 50% or higher decline in HRS-D score from baseline. RESULTS Compared with pessimists, optimists had lower baseline mean HRS-D scores (8 versus 15, p = .001). Among depressed patients, optimists were more likely to respond to treatment at 8 months (58% versus 27%, odds ratio = 3.02, 95% confidence interval = 1.28-7.13, p = .01), a finding that was not sustained in the intervention group. The optimism subscale, but not the pessimism subscale, predicted treatment response. By 8 months, optimists were less likely to be rehospitalized (odds ratio = 0.54, 95% confidence interval = 0.32-0.93, p = .03). CONCLUSIONS Among depressed post-CABG patients, optimists responded to depression treatment at higher rates. Independent of depression, optimists were less likely to be rehospitalized by 8 months after CABG. Further research should explore the impact of optimism on these and other important long-term post-CABG outcomes.
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Affiliation(s)
- Hilary Tindle
- Department of Medicine, University of Pittsburgh, 230 McKee Pl, Suite 600, Pittsburgh, PA 15213, USA.
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Baumeister H, Hutter N, Bengel J, Härter M. Quality of life in medically ill persons with comorbid mental disorders: a systematic review and meta-analysis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2011; 80:275-86. [PMID: 21646822 DOI: 10.1159/000323404] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 12/02/2010] [Indexed: 01/20/2023]
Abstract
BACKGROUND This systematic review aims to investigate the association between comorbid mental disorders and quality of life (QoL) in patients with chronic medical diseases. METHODS Studies investigating adults with diabetes mellitus, coronary artery disease, asthma, chronic back pain and colorectal cancer were included. Two reviewers independently extracted data and assessed methodological criteria. Effect sizes for QoL scores were analyzed in random-effects meta-analyses. Subgroup and sensitivity analyses were conducted. RESULTS The database search identified 7,291 references and 65 primary studies were included. Medically ill persons with comorbid mental disorders showed a significantly decreased overall (d = -1.10; 95% CI = -1.34 to -0.86), physical (d = -0.64; 95% CI = -0.74 to -0.53) and psychosocial (d = -1.18; 95% CI = -1.42 to -0.95) QoL compared to persons without mental disorders. Subgroup analyses did not reveal significant differences between the examined medical diseases or mental disorders. CONCLUSION The review provides evidence of a substantially reduced psychosocial and physical QoL in medically ill patients with comorbid mental disorders. This patient-reported outcome highlights the importance of recognizing and treating comorbid mental disorders in the medically ill.
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Affiliation(s)
- Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
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Singh M, Rihal CS, Lennon RJ, Spertus JA, Nair KS, Roger VL. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes 2011; 4:496-502. [PMID: 21878670 DOI: 10.1161/circoutcomes.111.961375] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND- Although older patients frequently undergo percutaneous coronary interventions (PCI), frailty, comorbidity, and quality of life are seldom part of risk prediction approaches. We assessed their incremental prognostic value over and above the risk factors in the Mayo Clinic risk score. METHODS AND RESULTS- Patients ≥65 years who underwent PCI were assessed for frailty (Fried criteria), comorbidity (Charlson index), and quality of life [SF-36]. Of the 628 discharged [median follow-up of 35.0 months (interquartile range, 22.7 to 42.9)], 78 died and 72 had a myocardial infarction (MI). Three-year mortality was 28% for frail patients, 6% for nonfrail patients. The respective 3-year rates of death or MI were 41% and 17%. After adjustment, frailty [hazard ratio (HR), 4.19 [95% confidence interval (CI), 1.85, 9.51], physical component score of the SF-36 (HR, 1.59; 95% CI, 1.24 to 2.02), and comorbidity, (HR, 1.10; 95% CI, 1.05, 1.16) were associated with mortality. Frailty was associated with mortality/MI (HR, 2.61, 1.52, 4.50). Models with conventional Mayo Clinic risk score had C-statistics of 0.628, 0.573 for mortality and mortality/MI, respectively. Adding frailty, quality of life, and comorbidity, the C-statistic was (0.675, 0.694, 0.671) for mortality and (0.607, 0.587, 0.576) for mortality/MI, respectively. Including frailty, comorbidities and SF-36, conferred a discernible improvement to predict death and death/MI (integrated discrimination improvement, 0.027 and 0.016, and net reclassification improvement of 43% and 18%, respectively). CONCLUSIONS- After PCI, frailty, comorbidity and poor quality of life are prevalent and are associated with adverse long-term outcomes. Their inclusion improves the discriminatory ability of the Mayo Clinic risk score derived from the routine cardiovascular risk factors.
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Affiliation(s)
- Mandeep Singh
- Divisions of Cardiovascular Diseases and Department of Health Sciences Research, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, and the Mayo Clinic and Mid America Heart Institute, Rochester, MN 55905, USA.
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Barnason S, Zimmerman L, Nieveen J, Schulz P, Miller C, Hertzog M, Tu C. Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery. Heart Lung 2010; 38:364-76. [PMID: 19755186 DOI: 10.1016/j.hrtlng.2009.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Revised: 01/13/2009] [Accepted: 01/28/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study objective was to examine the effect of a symptom management (SM) telehealth intervention on physical activity and functioning and to describe the health care use of older adult patients (aged > 65 years) after coronary artery bypass surgery (CABS) by group (SM intervention group and usual care group). METHODS A randomized clinical trial design was used. The study was conducted in 4 Midwestern tertiary hospitals. The 6-week SM telehealth intervention was delivered by the Health Buddy (Health Hero Network, Palo Alto, CA). Measures included Modified 7-Day Activity Interview, RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA), physical activity and exercise diary, Medical Outcomes Study Short-Form 36, and subjects' self-report and provider records of health care use. Follow-up times were 3 and 6 weeks and 3 and 6 months after CABS. RESULTS Subjects (N = 232) had a mean age of 71.2 (+4.7) years. There were no significant interactions using repeated-measures analyses of covariance. There was a significant group effect for average kilocalories/kilogram/day of estimated energy expenditure as measured by the RT3 accelerometer, with the usual care group having a higher estimated energy expenditure. Both groups had significant improvements over time for role-physical, vitality, and mental functioning. Both groups had similar health care use. CONCLUSION Subjects were able to return to preoperative levels of functioning between 3 and 6 months after CABS and to increase their physical activity over reported preoperative levels of activity. Further study of those patients undergoing CABS who could derive the most benefit from the SM intervention is warranted.
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Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center, Lincoln, 68588-0220, USA
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Abstract
OBJECTIVE To describe the relationship between pain and depression on recovery after coronary artery bypass grafting (CABG). METHODS A secondary data analysis on 453 depressed and nondepressed post-CABG patients enrolled in a randomized, controlled, effectiveness trial of telephone-delivered collaborative care for depression. Outcome measures were collected from March 2004 to September 2007 and included pain, physical function, and mood symptoms. RESULTS Depressed patients (baseline Patient Health Questionnaire-9 score ≥10) versus those without depression reported significantly worse pain scores on the 36-Item Short Form Health Survey Bodily Pain Scale at baseline and up to 12 months post-CABG, p < .05. Among patients with depression, those who received collaborative care reported significantly better pain scores at each time point between 2 and 12 months post-CABG versus depressed patients randomized to the usual care control group, p < .05. Regardless of intervention status, depressed participants with at least moderate pain at baseline reported significantly lower functional status (measured by the Duke Activity Status Index) at 8 and 12 months versus depressed patients with none or mild pain, p < .05. Depressed patients with at least moderate pain at baseline were also significantly less likely to show improvement of depressive symptoms throughout the course of follow-up versus depressed patients with little or no pain, p < .05. These findings controlled for age, gender, education, race, comorbid conditions, and baseline pain diagnosis. CONCLUSIONS Depression and pain seem to influence functional recovery post-CABG. The relationship between these two conditions and 12-month outcomes should be considered by clinicians when planning treatment.
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Smoking Cessation has no Influence on Quality of Life in Patients with Peripheral Arterial Disease 5 Years Post-vascular Surgery. Eur J Vasc Endovasc Surg 2010; 40:355-62. [DOI: 10.1016/j.ejvs.2010.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 05/24/2010] [Indexed: 11/20/2022]
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Hedlund M, Ronne-Engström E, Carlsson M, Ekselius L. Coping strategies, health-related quality of life and psychiatric history in patients with aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 2010; 152:1375-82; discussion 1382. [PMID: 20440628 PMCID: PMC2901493 DOI: 10.1007/s00701-010-0673-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 04/20/2010] [Indexed: 11/26/2022]
Abstract
Purpose Subarachnoid haemorrhage (SAH) reduces health-related quality of life (HRQoL) and increases the risk of psychiatric sequels such as depression and posttraumatic stress disorder. Especially those with a psychiatric history and those using maladaptive coping strategies are at risk for such sequels. The extent to which HRQoL after SAH was related to a history of psychiatric morbidity and to the use of various coping strategies was assessed. Methods Patients admitted to the Uppsala University Hospital with aneurysmal SAH (n = 59) were investigated prospectively. Seven months after SAH, data were collected using the Structured Clinical Interview for DSM-IV axis I disorders, the Short Form-36 (SF-36) Health Survey and the Jalowiec Coping Scale. Results Patients with SAH had lower HRQoL than the general Swedish population in all eight domains of the SF-36. The lower HRQoL was almost entirely in the subgroup with a psychiatric history. HRQoL was also strongly correlated to the use of coping. Physical domains of SF-36 were less affected than mental domains. Those with a psychiatric history used more coping than the remainder with respect to all emotional coping scales. Coping and the presence of a psychiatric history were more strongly related to mental than to physical components of HRQoL. Conclusions A psychiatric history and the use of maladaptive emotional coping were related to worse HRQoL, more to mental than to physical aspects.
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Škodová Z, van Dijk JP, Nagyová I, Rosenberger J, Ondušová D, Middel B, Reijneveld SA. Psychosocial predictors of change in quality of life in patients after coronary interventions. Heart Lung 2010; 40:331-9. [PMID: 20561888 DOI: 10.1016/j.hrtlng.2009.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/20/2009] [Accepted: 12/10/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQOL) after coronary interventions (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty) usually improves in patients, but not in all patients. Some patients actually show a significant decline in HRQOL. Our aim was to explore the potential of psychologic well-being (anxiety, depression), vital exhaustion, Type D personality, and socioeconomic position as predictors of HRQOL in patients with coronary disease. METHODS A total of 106 patients scheduled for coronary angiography were interviewed before (baseline) and 12 to 24 months after coronary angiography. Socioeconomic status was evaluated by education. The General Health Questionnaire 28 was used for measuring psychologic well-being (anxiety, depression), the Maastricht interview was used for measuring vital exhaustion, and the Type D questionnaire was used for measuring personality. HRQOL was assessed using the Short Form-36 (physical and mental components) questionnaire. Functional status was assessed with a combination of New York Heart Association and Canadian Cardiovascular Society classifications. Linear regressions were used to analyze data. RESULTS A change in physical HRQOL was predicted by baseline psychologic well-being (β = -.39; 95% confidence interval [CI], -1.00 to -.16) and baseline HRQOL (β = -.61; 95% CI, -.83 to -.34). A change in mental HRQOL was predicted by (baseline) psychologic well-being (β = -.37; 95% CI, -.99 to -.09), vital exhaustion (β = -.21; 95% CI, -.69 to -.03), and baseline HRQOL (β = -.76; 95% CI, -1.03 to -.44). Ejection fraction did not significantly predict HRQOL. CONCLUSION Psychosocial factors (psychologic well-being, vital exhaustion) seem to be more important predictors of change in HRQOL compared with some objective medical indicators (ejection fraction) among patients with coronary disease.
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Affiliation(s)
- Zuzana Škodová
- University of PJ Safarik, KISH-Kosice Institute for Society and Health, Kosice, Slovakia.
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Predictors for physical and mental health 6 months after coronary artery bypass grafting: a cohort study. Eur J Cardiovasc Nurs 2010; 9:238-43. [PMID: 20219433 DOI: 10.1016/j.ejcnurse.2010.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 01/26/2010] [Accepted: 02/12/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Knowledge of predictors for health related quality of life (HRQoL) after coronary artery bypass grafting is limited. AIM To identify preoperative and postoperative factors related to physical and mental health status 6 months after surgery. METHODS 185 patients completed the Short Form-36 survey preoperatively and 6 months after surgery. Multiple linear regression was used to identify significant independent predictors for both physical and mental health component summary scores 6 months after surgery. RESULTS Significant predictors for physical health were preoperative physical status (PCS), marital status, hospitalised with acute myocardial infarction and serum creatine kinase-MB (CK-MB) 1st postoperative day. Preoperative mental status (MCS and anxiety and/or depression symptoms) and postoperative pleural drainage were significant predictors of mental health 6 months after surgery. CONCLUSION This study identified predictors that have an impact on CABG patients' HRQoL 6 months after surgery. These predictors could cause elevated risk for morbidity and mortality. Clinicians have the opportunity to improve the HRQoL of CABG patients by targeting counselling and/or interventions focusing on the identified predictors.
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Valve replacement in the elderly patients. Indian J Thorac Cardiovasc Surg 2010. [DOI: 10.1007/s12055-009-0044-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Shelley M, Pakenham KI, Frazer I. Cortisol changes interact with the effects of a cognitive behavioural psychological preparation for surgery on 12-month outcomes for surgical heart patients. Psychol Health 2009; 24:1139-52. [DOI: 10.1080/08870440802126704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rollman BL, Belnap BH, LeMenager MS, Mazumdar S, Houck PR, Counihan PJ, Kapoor WN, Schulberg HC, Reynolds CF. Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial. JAMA 2009; 302:2095-103. [PMID: 19918088 PMCID: PMC3010227 DOI: 10.1001/jama.2009.1670] [Citation(s) in RCA: 284] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Van Breugel HNAM, Nieman FHM, Accord RE, Van Mastrigt GAPG, Nijs JFMA, Severens JL, Vrakking R, Maessen JG. A prospective randomized multicenter comparison on health-related quality of life: the value of add-on arrhythmia surgery in patients with paroxysmal, permanent or persistent atrial fibrillation undergoing valvular and/or coronary bypass surgery. J Cardiovasc Electrophysiol 2009; 21:511-20. [PMID: 19925605 DOI: 10.1111/j.1540-8167.2009.01655.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This is a multicenter, prospective, randomized controlled trial to determine the effect of add-on arrhythmia surgery on health-related quality of life during 1-year follow-up of cardiac surgery patients with atrial fibrillation. METHODS 150 patients with documented atrial fibrillation were randomly assigned to undergo cardiac surgery with or without add-on surgery. Patients completed quality of life questionnaires, comprising the RAND 36-item Health Survey 1.0 (SF-36), Multidimensional Fatigue Inventory-20 (MFI-20) and EuroQoL (EQ-5D and VAS) at baseline and 3, 6, and 12 months following operation. RESULTS 132 patients completed the questionnaires at a minimum of one time-point during follow-up. At baseline patient characteristics, operative data and health-related quality of life were comparable. At 12-month follow-up 62 patients were free of atrial fibrillation without significant differences between groups (P = 0.28). Conversion to SR occurred in 69.8% (37/53) of patients with paroxysmal AF, in 28.2% (11/39) of patients with permanent AF and in 44.4% (12/27) of patients in persistent AF. Cardiac surgery in general resulted in an overall improvement of the RAND SF-36 and the MFI-20. However, the EQ-5D showed a significant deterioration in the subscale Pain/Discomfort for both groups (P < 0.001), with a significant worse outcome for the control group (P = 0.006). CONCLUSIONS Health-related quality of life in patients with paroxysmal, permanent and persistent atrial fibrillation improves after cardiac surgery regardless of giving add-on surgery or not, but this improvement is presumably more affected by treating the underlying heart disease than by restoring sinus rhythm.
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Affiliation(s)
- H N A M Van Breugel
- Department of Cardiothoracic Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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Preoperative echocardiographic parameters influencing quality of life five years after coronary artery bypass graft surgery. VOJNOSANIT PREGL 2009; 66:718-23. [PMID: 19877550 DOI: 10.2298/vsp0909718z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Factors associated with mortality and morbidity following coronary artery bypass graft surgery have been well defined and the Parsonnet score is widely used in mortality prediction. The evaluation of quality of life has not been still implemented in everyday work and preoperative echocardiographic factors affecting the quality of life in patients undergoing coronary artery bypass graft surgery have been poorly documented. The aim of this study was to evaluate echocardiographic parameters influencing quality of life following coronary artery bypass graft surgery and its correlation with widely used Parsonnet score. METHODS A total of 449 consecutive patients with myocardial revascularization, operated during 1999 and 2000 were enrolled in this retrospective-prospective study. The patients with comorbidities were excluded as well as those with in complete myocardial revascularization. A group of 180 patients who accepted to participate in quality of life evaluation was followed for 60 months. The quality of life was evaluated using a questionnaire SF-36. RESULTS The mean patients' age was 57.8 +/- 7.8 years, 79.4% were males. A 5-year survival was 84.2%. The mean number of risk factors was 3.4 +/- 1.0. Most of the patients were in New York Heart Association (NYHA) II class (104 of them or 59.4%), 61 of them (34.9%) in NYHA III class and only 10 patients or 5.7% of them were in NYHA IV class. The mean End-Diastolic Diameter (EDD) was 55.3 +/- 5.6 mm, mean End-Systolic Diameter (ESD) 38.7 +/- 5.6 mm and mean ejection fraction (EF) 51.7 +/- 9.6%. Left atrium dilatation (p < 0.001), as well as left ventricle dilatation (p < 0.001), low left ventricle ejection fraction (p < 0.001), multisegmental disorders of contractility (p < 0.001), and severe mitral regurgitation (p < 0.001) were in negative correlation with almost all dimensions of quality of life. ROC analysis showed that left ventricle EDD of 54.5 mm can be used as good cut-off value for prediction of optimal quality of life, with sensitivity of 57% and specificity of 70% (RR = 1.386), left ventricle ESD of 37.5 mm with sensitivity of 65% and specificity of 57% (RR = 0.855) and left ventricle EF of 50% with sensitivity of 61% and specificity of 70% (RR = 0.916). CONCLUSION Echocardiographic parameters, that can easily be obtained preoperatively, have strong predictive value not only in postoperative survival, but also in determination of the quality of life of the patients five years after coronary artery bypass graft surgery.
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Tully PJ, Baker RA, Turnbull DA, Winefield HR, Knight JL. Negative emotions and quality of life six months after cardiac surgery: the dominant role of depression not anxiety symptoms. J Behav Med 2009; 32:510-22. [PMID: 19757015 DOI: 10.1007/s10865-009-9225-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 08/25/2009] [Indexed: 10/20/2022]
Abstract
The specific syndromal aspects of depression and anxiety have not been explored in relation to changes in health related quality of life (HRQOL) after cardiac surgery. The purpose of this study was to examine the impact of general stress, depression and anxiety on HRQOL after coronary artery bypass graft (CABG) surgery. Utilizing a tripartite conceptual model of depression and anxiety, it was hypothesized that general stress symptoms, rather than unique depressive or anxiogenic symptoms, would be associated with lower HRQOL 6 months after CABG surgery. Elective CABG patients (n=226) completed baseline and postoperative self-report measures of negative emotions and HRQOL, and 193 patients completed these measures at 6-month follow-up. Multiple linear regression analyses and logit link analyses were performed to test the hypothesis. Elevated depression symptoms before and after surgery showed an association with lower and worse HRQOL for vitality and social role functioning and physical and general health. This study adds to previous research by outlining discrete associations between specific HRQOL domains, and is perhaps the first to test a theoretical model of depression and anxiety in relation to cardiac CABG patients' perceptions of HRQOL. These findings encourage further research on negative emotions and HRQOL in cardiac surgery patients and the practical implications of these findings are discussed.
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Affiliation(s)
- Phillip J Tully
- Cardiac and Thoracic Surgical Unit, Department of Medicine, Flinders Medical Centre and Flinders University, Level 6 Flinders Private Hospital, Bedford Park, Adelaide, SA 5042, Australia.
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Quist-Paulsen P, Bakke PS, Gallefoss F. Does smoking cessation improve Quality of Life in patients with coronary heart disease? SCAND CARDIOVASC J 2009; 40:11-6. [PMID: 16448992 DOI: 10.1080/14017430500384855] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether smoking cessation after a coronary event improves quality of life, and to assess whether quality of life is a predictor of smoking cessation. DESIGN Health-related quality of life at baseline and at 12 months follow up were measured in a randomised smoking cessation trial of 240 smokers aged under 76 years admitted for myocardial infarction, unstable angina or coronary bypass surgery. At 12 months follow up 101 had managed to give up smoking (quitters), and 117 were smokers (sustained smokers). RESULTS The quitters and sustained smokers had similar improvements in all quality of life domains from baseline to 12 months follow up. Further, after adjustment for differences in baseline characteristics, the quality of life was not significantly different in the quitters compared to the sustained smokers neither at baseline nor at 12 months follow up. CONCLUSIONS Smoking cessation did not improve quality of life compared to sustained smoking after a coronary event in a 12 month follow up. Quality of life was not a significant predictor of smoking cessation.
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Gjeilo KH, Wahba A, Klepstad P, Lydersen S, Stenseth R. Health-related quality of life three years after coronary surgery: A comparison with the general population. SCAND CARDIOVASC J 2009; 40:29-36. [PMID: 16448995 DOI: 10.1080/14017430500339321] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To assess health-related quality of life (HRQOL) in patients three years after coronary artery bypass grafting (CABG) compared to the general Norwegian population, with emphasis on age and gender-differences. DESIGN A cross-sectional postal survey of patients who underwent CABG in 2000. HRQOL was assessed using the Short Form 36 (SF-36). Subgroup analyses were performed according to age (<70 versus =70 years) and gender. RESULTS Of 233 eligible patients 203 responded (mean age 67.6 years, 17% females). Patients reported better scores on bodily pain than the general population (p=0.008), but did not differ on other subscales of SF-36. Younger patients tended to score lower, older patients higher than the general population on HRQOL. Female patients reported lower HRQOL than the general female population and reported significantly lower scores than male patients on 3 of 8 subscales. CONCLUSIONS Three years after CABG the HRQOL is comparable to the general Norwegian population even in older patients. The older patients reported less pain than the general population.
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Affiliation(s)
- Kari Hanne Gjeilo
- Department of Cardiothoracic Surgery, St. Olavs HospitalTrondheim University Hospital, Trondheim, Norway.
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Patients' and significant others' health-related quality of life one month after coronary artery bypass grafting predicts later health-related quality of life. Heart Lung 2009; 38:318-29. [DOI: 10.1016/j.hrtlng.2008.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 05/06/2008] [Accepted: 07/30/2008] [Indexed: 11/22/2022]
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Barnason S, Zimmerman L, Schulz P, Tu C. Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden. Heart Lung 2009; 38:459-68. [PMID: 19944870 DOI: 10.1016/j.hrtlng.2009.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 01/05/2009] [Accepted: 01/28/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Older adults with poor functioning preoperatively are at risk for delayed recovery and more impaired outcomes after coronary artery bypass surgery (CABS). The study objective was to determine whether a 6-week early recovery telehealth intervention, designed to improve self-efficacy and management related to symptoms after CABS, was effective in improving outcomes (physical activity, physiologic, and psychologic functioning) for older adults (aged > 65 years) with higher disease burden. METHODS A descriptive, repeated-measures experimental design was used. Follow-up data were collected at 3 and 6 weeks and 3 months after CABS. Subjects were drawn from a larger randomized clinical trial. Parent study subjects who had high disease burden preoperatively (physical component score of < 50 on the Medical Outcome Study Short Form-36 and RISKO score of > 6) were included (N = 55), with 23 subjects in the early recovery intervention group and 31 subjects in the usual care group (n = 31). Subjects ranged in age from 65 to 85 years (M = 71.6 + 5.1 years). RESULTS There was a significant main effect by group (F[1,209] = 4.66, P < .05). The intervention group had a least square means of 27.9 kcal/kg/d of energy expenditure compared with the usual care group of 26.6 kcal/kg/d per the RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA). Both groups had significantly improved physical (F[2,171] = 3.26, P < .05) and role-physical (F[2,171] = 6.64, P < .005) functioning over time. CONCLUSION The subgroup of subjects undergoing CABS with high disease burden were responsive to an early recovery telehealth intervention. Improving patients' physical activity and functioning can reduce morbidity and mortality associated with poor functioning after cardiac events.
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Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, Nebraska, USA
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Djärv T, Blazeby JM, Lagergren P. Predictors of postoperative quality of life after esophagectomy for cancer. J Clin Oncol 2009; 27:1963-8. [PMID: 19289614 DOI: 10.1200/jco.2008.20.5864] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To identify factors predictive of health-related quality of life (HRQL) 6 months after surgery for esophageal cancer. PATIENTS AND METHODS A Swedish nationwide population-based study of patients undergoing esophagectomy for cancer was undertaken between 2001 and 2005. Clinical details (sex, age, body mass index [BMI], comorbidity) and tumor details (histology, stage, and location) were prospectively recorded and validated. HRQL questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30 and OES18) were used to assess HRQL 6 months postoperatively. HRQL outcome was categorized as good or poor by collapsing the four response categories. Logistic regression models adjusting for potential confounding factors were used to assess the association between preoperative patient and tumor characteristics and HRQL outcome 6 months after surgery. RESULTS A total of 355 patients (77% of eligible) responded to the HRQL questionnaires. Age, sex, and BMI showed no associations with HRQL 6 months after surgery, but patients with comorbidity, a more advanced tumor stage (III to IV), or a tumor located in the middle or upper esophagus had an increased risk of poor HRQL. Patients with adenocarcinoma had a lower risk of poor HRQL than patients with squamous cell carcinoma. CONCLUSION Knowledge of risk factors for poor postoperative HRQL may be relevant for clinical decision making. More research to see whether these factors are further predictive of poor HRQL in long-term survivors is needed.
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Affiliation(s)
- Therese Djärv
- Unit of Esophageal and Gastric Research P9:03, Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
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Rollman BL, Belnap BH, LeMenager MS, Mazumdar S, Schulberg HC, Reynolds CF. The Bypassing the Blues treatment protocol: stepped collaborative care for treating post-CABG depression. Psychosom Med 2009; 71:217-30. [PMID: 19188529 PMCID: PMC4573662 DOI: 10.1097/psy.0b013e3181970c1c] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Koch CG, Khandwala F, Blackstone EH. Health-related quality of life after cardiac surgery. Semin Cardiothorac Vasc Anesth 2009; 12:203-17. [PMID: 18805855 DOI: 10.1177/1089253208323411] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Health-related quality of life (HRQOL) assessments are designed to reflect a patient's perspective of how a disease has affected their overall health status. Patient-centered outcomes are of value both for risk assessment and as an outcome measure. Strategies for analyzing HRQOL data are inconsistent primarily because the data frequently do not meet underlying assumptions of traditional methods for statistical analyses and require a careful analytic approach.
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Abstract
Patient-centered health status measures-assessments of patients' symptoms, function, and quality of life-have matured substantially over the past 2 decades. Currently, valid, reliable, and sensitive disease-specific measures are available for quantifying the health status of patients with cardiovascular disease. This article briefly reviews the concept of health status measures, with a focus on their interpretation. It then discusses both the rationale and potential applications of health status measures in clinical care. Health status measures are not surrogate measures of outcome but rather highly meaningful outcomes of care. As such, they have important emerging roles as outcomes in clinical trials, as tools for monitoring patients in routine clinical care, as a mechanism for operationalizing and evaluating disease management programs, and as tools for quality assessment/improvement. Over time, it is expected that health status measures will also have an increasingly important role in patient-centered medical decision making. By becoming aware of the evolving roles of health status measures, clinicians can help to accelerate the realization of the Institute of Medicine's vision for a more transparent, evidence-based, patient-centered healthcare system.
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Affiliation(s)
- John A Spertus
- University of Missouri at Kansas City School of Medicine, Kansas City, Mo., USA.
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Rantanen A, Kaunonen M, Sintonen H, Koivisto AM, Astedt-Kurki P, Tarkka MT. Factors associated with health-related quality of life in patients and significant others one month after coronary artery bypass grafting. J Clin Nurs 2008; 17:1742-53. [PMID: 18592625 DOI: 10.1111/j.1365-2702.2007.02195.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To describe and compare the health-related quality of life of patients and their significant others and to identify factors associated with health-related quality of life one month after coronary artery bypass surgery. BACKGROUND Heart disease and coronary artery bypass surgery affect the life of patients and their significant others. Following surgery, some patients might feel their quality of life is poor. Significant others are a major source of support for patients; therefore, it is important to know how their health-related quality of life is affected. METHODS This study is part of a major longitudinal research project. The questionnaire data for the study were collected one month after the surgical procedure from 270 patients and 240 significant others at one Finnish university hospital. Data analysis was by descriptive and inferential statistics. Stepwise linear regression analysis was used as a multivariate method. RESULTS Coronary artery bypass grafting patients had a poorer health-related quality of life than both the age and gender-standardised general population and their significant others. Significant others, on the other hand, had the same health-related quality of life as the general population. In patients, health-related quality of life was associated with the occurrence of cardiac symptoms and New York Heart Association class; in significant others, it was explained by chronic illnesses, employment, gender and emotional support received from members of the support network. CONCLUSION In the early stages of recovery, the health-related quality of life of coronary artery bypass grafting patients is inferior to that of the general population. There are also differences in the health-related quality of life of patients and their significant others. RELEVANCE TO CLINICAL PRACTICE Postcoronary artery bypass grafting rehabilitation programmes should provide support for both patients and significant others through networks that involve both professionals and peer supporters.
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Affiliation(s)
- Anja Rantanen
- Department of Nursing Science, University of Tampere, Tampere, Finland.
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Markou ALP, van der Windt A, van Swieten HA, Noyez L. Changes in quality of life, physical activity, and symptomatic status one year after myocardial revascularization for stable angina. Eur J Cardiothorac Surg 2008; 34:1009-15. [PMID: 18778947 DOI: 10.1016/j.ejcts.2008.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 07/17/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND This study investigates changes of quality of life (QOL), physical activity (PA) and symptomatic status (NYHA) at one-year post-coronary artery bypass grafting (CABG). METHODS Of 568 patients undergoing a primary isolated CABG for stable angina (NYHA <IV) pre- and 1-year postoperative data on QOL, PA, and NYHA were complete. Studied outcomes were changes in QOL, EuroQoL questionnaire, PA, the Corpus Christi Heart Project criteria and NYHA. Analysis was based on three age groups. Group A, age <65 years: 285 patients, group B, 65-74 years: 210 patients, and group C, age >or=75 years: 73 patients. RESULTS There is a similar, significant decrease of NYHA class (1.4) for the three groups (p<0.0005). An overall significant improvement for QOL and PA is however different in the three subgroups. PA improvement is not significant in group C (p=0.74), significant in group B (p=0.005) and in group A (p<0.0005). For the QOL, group A shows a significant improvement for the five different domains, group B for two, and group C only for one domain. The visual analogue score as part of the QOL registration shows a significant increase for the three groups, however the improvement is minor with age, and between A (14.6) and C (9.1) this improvement is significantly different (p=0.047). CONCLUSIONS Elderly patients have the same improvement of their symptomatic status as younger patients. However despite this improvement they have less benefit from CABG regarding to their quality of life and physical activity.
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Affiliation(s)
- Athanasios L P Markou
- Heart Center, Radboud University Nijmegen, Department of Cardio-Thoracic Surgery, Nijmegen, The Netherlands
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Cserép Z, Losoncz E, Malik A, Székely A, Balog P, Kopp M. [Psychosocial factors determining life expectancy of patients undergoing open heart surgery]. Orv Hetil 2008; 149:1549-54. [PMID: 18687573 DOI: 10.1556/oh.2008.28383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Not only the physical status of the patient and the clinical variables determine the outcome and recovery following open heart surgery. Psychosocial and socioeconomic factors have growing importance regarding this field. During the last decades, in the assessment of the results of revascularization the self-perceived health related quality of life of the patient has come into the limelight. Evidence suggests that self-perceived health related quality of life, depressive symptoms and anxiety together influence short and long term recovery following coronary bypass surgery. There is also a higher risk for morbidity and mortality among the lonely and the socially isolated. Lower education and poor social background may play a role in the higher mortality rates. In our review we summarize the psychosocial factors determining the outcome of heart surgery.
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Affiliation(s)
- Zsuzsanna Cserép
- Gottsegen György Országos Kardiológiai Intézet, Budapest, Hungary
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