Patients' and partners' health-related quality of life before and 4 months after coronary artery bypass grafting surgery

Post-Infarction Ventricular Septal Defect: A quarter century experience

Objectives

Post-infarction ventricular septal defect (VSD) is one of the known complications after acute myocardial infarction. This study investigated the clinical results after surgical repair of VSD.

Methods

This retrospective study included all patients undergoing surgical repair of VSD from 1996 to 2020 in Oman.

Results

Out of a total of 75 patients, 62.5% were men, with a mean age of 59 years. The mean follow-up was 17.2 (7.5) years. Of the 75 patients, 34 (45.3%) patients died within 30 days. Total survival was 41.3% at 5 years, while the 10-year survival rate was 33.3%. Outcomes and predictors for 30 days mortality were the number of concomitant coronary involvement and anastomoses performed, residual postoperative shunt and postoperative dialysis.

Conclusion

Even with surgical repair, early mortality of post-infarction septal defect is still considerably high. Early repair and the anatomically posterior rupture are predictors of early mortality. In patients surviving the immediate postoperative period, long-term survival is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt.

What's love got to do with it? Relationship quality appraisals and quality of life in couples facing cardiovascular disease

Objective

Changes in couples' relationship quality are common post-cardiac event but it is unclear how relationship quality is linked to patients' and spouses' quality of life (QoL). The purpose of the present study was to examine the association between relationship quality on QoL in patient-spouse dyads within six months of a cardiac event.

Methods

Participants (N = 181 dyads; 25.9% female patients), recruited from a large cardiac hospital, completed validated questionnaires measuring demographic, relationship (Dyadic Adjustment Scale; DAS) and QoL variables (Heart-QoL & Quality of life of Cardiac Spouses Questionnaire). An Actor-Partner Interdependence Model was used to investigate actor (i.e. responses influencing their own outcome) and partner effects (responses influencing their partner's outcome) of relationship quality and QoL.

Results

Patients' and spouses' perceptions of relationship quality were in the satisfied range (DAS > 108; 65% of sample) and, as expected, patients reported lower general physical QoL than did their spouse (t(180) = -10.635, p < .001). Patient and spouse relationship quality appraisals were positively associated with their own physical (patient β = .25; spouse β = .05) and emotional/social (patient β = .21; spouse β = .04) QoL. No partner effects were identified.

Conclusion

High quality relationship appraisals appear to matter for patients' and spouses' QoL after the onset of CVD.

Predictors of health-related quality of life after coronary artery bypass graft surgery

Health-related quality of life (HRQOL) is a multifactorial concept in assessing physical and mental health. This study was performed to evaluate the HRQOL of patients undergoing coronary artery bypass graft (CABG) surgery and the predictors of HRQOL in patients until 1 year after surgery. This cross-sectional study included 110 consecutive patients who underwent elective CABG in a medical center in South Korea. The Short-Form Health Survey, cardiac symptom survey, cardiac self-efficacy, and the Interpersonal Support Evaluation List-12 were used to measure the HRQOL, symptom experience, self-efficacy, and social support, respectively. The regression model explained 42% of the variance in the participants' physical HRQOL. The predictors of the physical HRQOL include the presence of a spouse, post-CABG duration, symptom experience, and self-efficacy. The regression model explained 36% of the variance in the participants' mental HRQOL. The predictors of the mental HRQOL included perceived health status, self-efficacy, and social support. The predictive factors for HRQOL after CABG were the presence of a spouse, post-CABG duration, symptom experience, self-efficacy, and social support. Furthermore, a suitable program and nursing interventions could be implemented to improve the HRQOL of post-CABG patients.

Improvement in Health-Related Quality of Life After Total Ankle Arthroplasty Compares Well With Other Successful Orthopaedic and Nonorthopaedic Procedures

Background. Ankle arthritis is a major cause of disability. Orthopaedic literature suggests improvement in health-related quality of life (HRQOL) after total ankle arthroplasty (TAA). This has not been compared with improvements observed in successful orthopaedic and nonorthopaedic procedures, including anterior cervical discectomy/fusion (ACDF), total knee arthroplasty (TKA), coronary artery bypass grafting (CABG), and orthotopic liver transplant (OLT). We hypothesize that the effects after TAA are comparable to several successful surgical procedures. Methods. 500 consecutive TAA patients were included and grouped with 2 other large series. Short Form-36 (SF36) were collected at standardized intervals. A systematic literature review identified studies comparing preoperative and postoperative SF36 physical (PCS) and mental component summary (MCS) scores. Using meta-analyses, we pooled the data for each procedure to compare with the TAA group. Results. Patients in all cohorts had preoperative SF36 MCS and PCS scores that were significantly lower than that in the general population. Improvements in HRQOL after TAA were not statistically different from improvements reported in PCS and MCS after ACDF, TKA, and OLT. However, improvement in PCS after TAA was better than that observed after CABG. Conclusions. Disability with ankle arthritis is severe. Disability associated with cervical disc disease, knee arthrosis, coronary artery disease, and liver failure is also severe, with surgical intervention providing major improvements in HRQOL postoperatively. The improvement in HRQOL after TAA did not differ statistically from ACDF, TKA, CABG, and OLT. Our investigation suggests that the HRQOL benefits of TAA meet benchmarks set by some of modern medicine's best.Levels of Evidence: Level III: Systematic review.

Dyadic effects of anxiety and depression on quality of life among couples facing cardiovascular disease

OBJECTIVE

Anxiety and depression are frequently comorbid in patients with cardiovascular disease (CVD) and a patient's poor mental health may implicate the quality of life (QoL) of a partner. The bidirectional effects of comorbid anxiety and depression on patient and partner outcomes are inadequately understood. The aim of this study was to investigate associations of the combined role of depression and anxiety on patients' and partners' QoL.

METHOD

In this cross-sectional study, patients with CVD and their partners completed questionnaires measuring anxiety, depression, and QoL. Dyadic data was analyzed using the Actor-Partner Interdependence Model and polynomial interaction for examining the synergistic and dysergistic effects of anxiety and depression (i.e., in combination).

RESULTS

181 dyads comprised the study sample (66.3% coronary artery disease; 25.9% female patients). Anxiety and depression, in synergy was associated with poorer QoL in patients and partners (actor effects). Patients that are more anxious than depressed have greater physical QoL whereas partners that are more depressed than anxious have greater emotional QoL (dysergistic actor effects). Patients' more severe symptoms of anxiety and depression, in synergy, was associated with partners' poorer QoL (partner effect).

CONCLUSION

Anxiety and depression are comorbid and associated with poor QoL in patients and their partners. The results may have implications for secondary prevention programming but future longitudinal studies are warranted to substantiate the cross-sectional findings.

The Impact of Caregiving Burden on Mental Well-Being in Coronary Artery Bypass Graft Surgery Caregivers: The Mediatory Role of Perceived Social Support

An increase in caregiver burden and a decrease in social support have both been identified as predictors of poor caregiver psychological distress. However, little is known about the role of these factors in coronary artery bypass graft (CABG) caregivers. The purpose of this study was to investigate whether change in perceived social support from pre to post surgery mediated the relationship between change in caregiver burden and caregiver depressive symptoms and subjective well-being post surgery. A sample of 101 caregivers of elective CABG patients were assessed 28 days before and 62 days after patients' surgery. Caregivers completed the Oberst Burden Scale, the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument, the Beck Depression Inventory, and the Control, Autonomy, Self-Realisation, and Pleasure (CASP-19) scale. Simple mediation analyses showed that change in social support significantly mediated both the relationship between change in caregiver burden and post-surgery depressive symptoms (unstandardised β = 0.041, 95% CI (0.005, 0.112)) and the relationship between change in caregiver burden and post-surgery subjective well-being (unstandardised β = 0.071, 95% CI (0.001, 0.200)). Psychological interventions aimed at the CABG caregiver population should promote social support to deal with the increase of caregivers' tasks and demands after the patients' surgery.

Longitudinal evaluation of the effects of illness perceptions and beliefs about cardiac rehabilitation on quality of life of patients with coronary artery disease and their caregivers

BACKGROUND

Patients' negative illness perceptions and beliefs about cardiac rehabilitation (CR) can influence uptake and adherence to CR. Little is known about the interpartner influence of these antecedent variables on quality of life of patients with coronary artery disease (CAD) and their family caregivers. The aims of the study were: 1) to assess differences in illness perceptions, beliefs about CR and quality of life between patients with CAD and their family caregivers upon entry to a CR programme and at 6 months follow-up; and 2) to examine whether patients' and caregivers' perceptions of the patient's illness and beliefs about CR at baseline predict their own and their partner's quality of life at 6 months.

METHODS

In this longitudinal study of 40 patient-caregiver dyads from one CR service, patients completed the Brief Illness Perception Questionnaire and Beliefs about Cardiac Rehabilitation Questionnaire at baseline and 6 months; and caregivers completed these questionnaires based on their views about the patient's illness and CR. The Short-Form 12 Health Survey was used to assess patients' and caregivers' perceived health status. Dyadic data were analysed using the Actor-Partner Interdependence Model.

RESULTS

Most patients (70%) were men, mean age 62.45 years; and most caregivers (70%) were women, mean age 59.55 years. Caregivers were more concerned about the patient's illness than the patients themselves; although they had similar scores for beliefs about CR. Patients had poorer physical health than caregivers, but their level of mental health was similar. Caregivers' poorer mental health at 6 months was predicted by the patient's perceptions of timeline and illness concern (i.e. partner effects). Patient's and caregiver's illness perceptions and beliefs about CR were associated with their own physical and mental health at 6 months (i.e. actor effects).

CONCLUSIONS

Overall, the patients and caregivers had similar scores for illness perceptions and beliefs about CR. The actor and partner effect results indicate a need to focus on specific illness perceptions and beliefs about CR, targeting both the individual and the dyad, early in the rehabilitation process to help improve patients and caregivers physical and mental health (outcomes).

Experiences of informal caregivers after cardiac surgery: a systematic integrated review of qualitative and quantitative studies

OBJECTIVES

To provide a comprehensive synthesis of informal caregivers' experiences of caring for a significant other following discharge from cardiac surgery.

DESIGN

Systematic integrated review without meta-analysis.

DATA SOURCES

A bibliographic search for publications indexed in six databases (Cochrane Library, CINAHL, MEDLINE, EMBASE, AMED and PsycINFO), including a scan of grey literature sources (GreyNet International, Google Scholar, Web of Science, WorldCat and the Clinical Trials Registry) was conducted in October 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they described views and perspectives of informal caregivers of cardiac surgery patients (non-intervention studies (qualitative and quantitative)), and the effectiveness of interventions to evaluate support programme for informal caregivers of cardiac surgery patients (intervention studies).

RESULTS

Of the 4912 articles identified in searches, 42 primary research studies were included in a narrative synthesis with 5292 participants, including 3231 (62%) caregivers of whom 2557 (79%) were women. The median sample size across studies was 96 (range 6-734). Three major themes emerged from the qualitative study data: (1) caregiver information needs; (2) caregiver work challenges and (3) caregivers adaption to recovery. Across the observational studies (n=22), similar themes were found. The trend across seven intervention studies focused on caregiver information needs related to patient disease management and symptom monitoring, and support for caregivers to reduce symptoms of emotional distress.

CONCLUSION

Informal caregivers want to assist in the care of their significant others after hospital discharge postcardiac surgery. However, caregivers feel insecure and overwhelmed and they lack clear/concise discharge information and follow-up support during the early at-home recovery period. The burden of caregiving has been recognised and reported since the early 1990s, but there remains a limited number of studies that assesses the effectiveness of caregiver interventions.

PROSPERO REGISTRATION NUMBER

CRD42018096590.

Effect of Digital Storytelling on Anxiety in Patients Who Are Candidates for Open-Heart Surgery

BACKGROUND

Open-heart surgery in persons with cardiovascular disease is associated with high levels of anxiety.

OBJECTIVE

The goal of this study was to determine the effect of digital storytelling on anxiety in patients who were candidates for open-heart surgery.

METHODS

In this quasi-experimental study, 80 patients were randomly allocated into 2 groups. The intervention group received routine training and digital storytelling. In each group, anxiety was measured by the State-Trait Anxiety Inventory anxiety scale before surgery and 5 days after surgery. The collected data were analyzed using SPSS software V18.

RESULTS

There was no significant difference in the anxiety of both groups during the 2 days before the surgery (P = .40). After the surgery, the mean of anxiety scores in the intervention group was lower than that of the control group (P < .001).

CONCLUSIONS

Digital storytelling is an effective method to reduce anxiety in patients who are candidates for open-heart surgery.

Specific needs, concerns, strategies and advice of caregivers after coronary artery bypass surgery

OBJECTIVE

To describe concerns, needs, strategies and advice of coronary artery bypass (CABG) caregivers during the first 3 months post-surgery.

BACKGROUND

Nearly 400,000 patients underwent CABG surgery in 2010. While caregiving demand and difficulty has been investigated in early (4-8 weeks), mid (3 month), and later (6-12 months) recovery, no studies have explored early-to-mid concerns in-depth.

METHODS

In this qualitative study, a purposive sample of CABG partners participated in structured interviews. Themes for burden concerns, needs and strategies were derived using constant comparative analysis.

RESULTS

One global theme 'knowing what I'm supposed to be doing' emerged. Specific themes related to medications, mobility, symptom monitoring, memory, appetite, emotional spirits, and finances.

CONCLUSIONS

The resounding need for a dedicated caregiver program to prepare partners for their role, including what to expect, warrants exploration. Future research should validate these concerns in more diverse samples so interventions can be targeted to better support caregivers.

Coronary revascularization in the elderly with stable angina

A proportion of elderly with coronary artery disease is rapidly growing. They have more severe coronary artery disease, therefore, derive more benefit from revascularization and have a greater need for it. The elderly is a heterogeneous group, but compared to the younger cohort, the choice of the optimal revascularization method is much more complicated among them. In recent decades, results has improved dramatically both in surgery and percutaneous coronary intervention (PCI), even in very old persons. Despite the lack of evidence in elderly, it is obvious, that coronary artery bypass surgery (CABG) has a more pronounced effect on long-term survival in price of more strokes, while PCI is certainly less invasive. Age itself is not a criterion for the selection of treatment strategy, but the elderly are often more interested in quality of life and personal independence instead of longevity. This article discusses the factors that influence the choice of the revascularization method in the elderly with stable angina and presents a complex algorithm for making an individual risk-benefit profile. As a consequence the features of CABG and PCI in elderly patients are exposed. Emphasis is centered on the frailty and non-medical factors, including psychosocial, as essential components in making the decision of what strategy to choose. Good communication with the patients and giving them unbiased information is encouraged.

Preoperative sleep complaints are associated with poor physical recovery in the months following cardiac surgery

BACKGROUND

Sleep disturbance is associated with poorer outcomes in cardiac patients, but little is known about the independent role of sleep quality in coronary artery bypass graft (CABG) patients.

PURPOSE

This study aims to examine the relationship between preoperative sleep complaints and post-operative emotional and physical recovery in CABG surgery patients, independently of demographic, clinical and mood factors.

METHODS

Two hundred thirty CABG patients (aged 67.81 ± 9.07 years) completed measures of self-reported sleep complaints before surgery and health-related quality of life (HRQoL), physical symptoms and pain 2 months after surgery.

RESULTS

Greater sleep complaints prior to surgery were associated with greater physical symptoms, poorer physical HRQoL and greater sensory pain after surgery (p < 0.05), but not with affective pain or mental HRQoL. Preoperative mood was not able to explain these associations.

CONCLUSIONS

Sleep complaints may be implicated in physical recovery from CABG surgery but further work is needed to understand the role of causal pathways.

Evaluating symptoms to improve quality of life in patients with chronic stable angina

Chronic stable angina (CSA) is a significant problem in the United States that can negatively impact patient quality of life (QoL). An accurate assessment of the severity of a patient's angina, the impact on their functional status, and their risk of cardiovascular complications is key to successful treatment of CSA. Active communication between the patient and their healthcare provider is necessary to ensure that patients receive optimal therapy. Healthcare providers should be aware of atypical symptoms of CSA in their patients, as patients may continue to suffer from angina despite the availability of multiple therapies. Patient questionnaires and symptom checklists can help patients communicate proactively with their healthcare providers. This paper discusses the prevalence of CSA, its impact on QoL, and the tools that healthcare providers can use to assess the severity of their patients' angina and the impact on QoL.