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Background:The applicability of the Short Form (SF36) questionnaire to disparate populations led us to use this tool to investigate how health-related quality-of-life (HRQoL) for patients who underwent coronary artery bypass grafting (CABG) is related to gender, age and survival.Method: SF36 data and the presence of cardiac symptoms were collected from 44 women and 166 men prior to surgery and from consenting survivors at one and eight-year follow-ups. Survival data were collected from government records for 18 years post operation. Paired t-tests, Pearson correlation coefficients, chi-squared tests and the log-rank test were used to investigate connections between HRQoL and age, presence of angina/breathlessness and survival within and across genders.Results: HRQoL improved significantly for males and females in almost all health domains at the one year follow-up. At the eight year follow-up most female domain scores showed further improvement whereas the majority of male domain scores declined. Cardiac symptoms were present in 75.8% of women and 68.3% of men (χ2=0.7120, p=0.3988) at the one-year follow-up, and 84.2% of women and 70.2% of men at the eight-year follow-up. Male long term survival (53.6% after 18 years) depended significantly on retaining post-operative improvements in HRQoL to the medium term (p<0.002 in 4 of 8 domains). Female long term survival (40.9%) was significantly less than male survival (p=0.0108) and depended on maintaining a steady upward trend in HRQoL over the medium term. Age was not a determinant in HRQoL following CABG. Long term male and female survival was not significantly different and approached those of age and gender matched samples from the general population. Conclusion:Strategies to improve HRQoL in women may support improved survival by reducing excess short term female mortality, but the effectiveness of the same strategy for men is less apparent.

Background: Coronary artery bypass grafting (CABG) is a major surgical intervention to relieve symptoms and promote survival for individuals with coronary heart disease (CHD). The benefits of the intervention are thought to be improved when underlying risk factors of CHD are ameliorated. However in current health care systems the long-term follow-up of patients following CABG is not centralized to allow for the determination of survival trends and their optimization. The survival of study participants who underwent CABG is compared with age and gender matched individuals from the general population. Differences in rates of survival are interpreted in terms of lifestyle choices and the impact of risk factors of CHD.Method: Survival data were obtained from government records to 18 years post intervention on a cohort of patients who underwent CABG and participated in a long-term follow-up program. Cardiac symptoms and risk factors of CHD were collected from consenting participants (44 women and 164 men) prior to CABG and at clinical assessments at one and eight-year follow-ups. Important clinical and lifestyle factors were identified and their impact on post-operative survival was quantified using a maximum likelihood technique. Male and female patients were investigated separately and a good fit between observed and simulated survival experiences was confirmed by Monte Carlo simulation.Results: Cardiac symptoms were exhibited by 75.8% of women and 68.3% of men (χ 2 =0.712, p=0.3988) one-year post operation, and by 84.2% of women and 70.2% of men eight-years post operation (χ 2 =1.556, p=0.212). Male longterm survival at 54.3% after 18 years was significantly better than 36.4% for females (χ 2 =4.449, p=0.035), but both were worse than 73.0% and 71.5% (p=0.6114) respectively for gender and age-matched cohorts from the general population.Important risk factors for women were post-operative smoking and postoperative hypertension reducing annual post-operative survival by 3.9% and 2.7% respectively and by 6.6% when both are present. Equivalent important risk factors for men are post-operative smoking and unrelieved/recurring cardiac symptoms reducing annual survival rates by 2.4% and 1.2% respectively and by 3.6% when both are present. Conclusion:Eighteen year survival post CABG was significantly better for men than women, but both were worse than that for the general population. Post-operative smoking was the most significant risk factor associated with decreased rates of survival followed by unrelieved/recurring cardiac symptoms for men and persisting hypertension for women.