Health-Related Quality of Life After Coronary Artery Bypass Grafting: A Review of Randomized Controlled Trials

Abstract

Objective outcome measures (i.e., survival, mortality, morbidity, complication rate, symptom recurrence, and need for re-interventions) have long been used as benchmarks for successful cardiac surgery, including coronary artery bypass grafting (CABG). Along with these objectively measurable outcome indicators, acquired improvement by cardiac surgery in subjectively experienced health-related quality of life (HRQoL) has gained importance during the last decade in cardiac surgical research. If an increasing proportion of adult patients referred for CABG are elderly, octogenarians or even nonagenarians, the acquired HRQoL benefit from bypass surgery should be considered to be at least as important an outcome measure as potentially marginal improvement in life expectancy or longevity alone. To achieve the maximal HRQoL benefit and to optimize patient selection, a comprehensive analysis and understanding of contributors that affect pre- and postoperative self-perceived HRQoL is essential. These include patient-related characteristics (e.g., demographics and underlying comorbidities), surgical technique-related factors, and healthcare-related attributes. In this paper we review the randomized controlled trials published during the last ten years to analyze the effect of CABG on HRQoL. Specifically, we focus on the differences between the on-pump and off-pump (OPCAB) bypass techniques, investigate the factors that contribute to post-CABG HRQoL, and study post-CABG HRQoL in elderly patients.

On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in Elderly Patients

“…6 Studies comparing self-assessed symptoms and quality of life (QoL) in younger patients have failed to show a significant benefit of 1 method over another. [11][12][13][14] Age is an independent predictor of major complications after cardiac surgery. Several authors have claimed that the benefits of OPCAB are more pronounced in elderly patients and patients with high comorbidity.…”

Health-Related Quality-of-Life Outcomes in Coronary Artery Bypass Surgery Patients and Partners

“…1,11–13 Early improvements in physical function following coronary heart diseases (CHD) events, 1 CABSs, 14 and CR programs 15,16 are well documented during the first 3 months. However, while some studies found improvements in physical function between postevent to 6 months, 2,17 others do not show improvements occurring between 3 and 6 months 15,16 or later. 5 Findings are confounded by the different instruments used to measure physical function 2,15–17 and varying time intervals examined.…”

“…However, while some studies found improvements in physical function between postevent to 6 months, 2,17 others do not show improvements occurring between 3 and 6 months 15,16 or later. 5 Findings are confounded by the different instruments used to measure physical function 2,15–17 and varying time intervals examined. 2,15–17 Often partners take on significant physical burdens such as additional housework and patient-related caregiving activities following CHD events.…”

“…5 Findings are confounded by the different instruments used to measure physical function 2,15–17 and varying time intervals examined. 2,15–17 Often partners take on significant physical burdens such as additional housework and patient-related caregiving activities following CHD events. 18,19 Very few studies examined partners physical HRQOL.…”

The safe surgeon

“…It is now very clear that heart surgery is safe effective and in some areas preserves life in terms of quality [2], although we are not sure any Cardiac Surgery can prolong life. The word prolong was perhaps used in comparison to the natural history of the disease rather than to adding extra years to one's life.…”