Effect of Functional Health-Related Quality of Life on Long-Term Survival After Cardiac Surgery

Abstract

Background-Health-related quality-of-life instruments have become important measures of early health outcomes after cardiac surgery. The relationship between quality of life after recovery from surgery and subsequent long-term survival has not previously been explored. Our objective was to determine whether the Duke Activity Status Index (DASI) was predictive of subsequent time-related survival after recovery from cardiac surgery. Methods and Results-We examined survival status among 6305 patients who underwent isolated coronary artery bypass grafting with or without valve procedures or isolated valve procedure between May 1995 and June 1998 who had a preoperative baseline and follow-up DASI. The postoperative DASI was administered nominally at 6 and 12 months. Baseline and perioperative variables and postoperative morbid events were prospectively collected concurrently with patient care. The end point was all-cause mortality. The Social Security Death Index was queried for survival status. Cox proportional-hazards analysis was used to study the associations between DASI, a number of traditional risk factors, and survival. Median follow-up was 8.6 years. The "dose-response" relationship between baseline and follow-up DASI and risk of long-term death was established.

Comprehensive Prospective Cognitive and Physical Function Assessment in Elderly Patients Undergoing Transcatheter Aortic Valve Implantation

“…The DASI questionnaire is used to evaluate the ability to perform common activities of daily living (higher scores represent better physical functioning), in which each item is weighted by its known metabolic cost. DASI has been commonly used in evaluating patients with cardiovascular diseases [12,26,27,28]. …”

Translation and cross-cultural adaptation of the Duke activity status index to Brazilian Portuguese

“…These changes made the items more suitable to Brazilian culture in order to achieve semantic equivalence (between words), idiomatic equivalence (between different idiomatic expressions used in the different cultures), experimental equivalence (words adequate to the cultural context) and conceptual equivalence (validity of the concept explored and events experienced by laypersons) (23,24). Studies have demonstrated that the DASI is correlated with the distance travelled on the Six-Minute Walk Test (r = 0.53) (10), B-type natriuretic peptide levels (r = 0.67) (13), the Canadian Cardiovascular Society Classification (r = 0.58) (7) and patient quality of life and survival (r = 0.64) (11). Moreover, the questionnaire is sensitive to changes in functional status between the preoperative and postoperative periods of cardiovascular surgery (8,12) and a predictor of the ability to return to work (14).…”

“…Based on these principles, Hlatky et al (5) created a self-administrated questionnaire denominated the Duke Activity Status Index (DASI) in the United States. This index is employed to predict cardiorespiratory fitness and has been widely used for patients with cardiovascular disease (7)(8)(9)(10)(11)(12)(13)(14).…”

Specificity of training in cardiac rehabilitation to facilitate a patient's return to strenuous work following aortic valve replacement

“…Conventional CR, in failing to address such patients' goals, runs the risk that they will "supplement" CR with unsupervised training, risking complications like sternal dehiscence. Alternatively, they may be unable to return to work, with associated reduced quality of life and survival, 9,16 or attempt to return without regaining adequate fitness, risking injury.…”