Spectrum of Quality of Life after Valve Surgery in Patients with Rheumatic Heart Disease.

Abstract

Background and Aims: Improvement in quality of life is one of the principal goals of valve surgery. The purpose of this study was to assess the quality of life in patients living with mechanical heart valves.
 Methods: We conducted a cross-sectional descriptive study among 131 (42 Males, and 89 Female) patients, who had undergone valve procedures at different times in clinic visit of department of cardiac surgery, unit I of Shahid Gangalal National Heart Centre from August 1 till August 29, 2019. Quality of life index was measured using Ferrans and Power quality of life index, cardiac version IV via written questionnaire or verbal interview.
 Results: Mean age was 40.57±1.4 (16-75) years. Mean duration of follow up was 4.68±4.03 years (3 months to 18 years). Subjects reported the lowest quality of life scores in the health and functioning domain prior to surgery (15.61±1.30), which improved 47.15% after surgery (22.95±0.45), psychological/spiritual domain improved 16.68%, social and economic domain 26.24%, family domain 11.49%, with overall improvement 28.62%. Women had significantly lower mean overall quality of life index (22.99±03.58) (95% confidence interval 22.24-23.75) compared to male counterparts (24.21±4.11) (95% confidence interval 22.92-25.49) (p<0.05). Family domain had the highest score at the latest follow up (28.84±1.63). There was a statistically significant correlation between the duration of operation and overall quality of life index (Pearson's rho 0.217, p<0.01). There was no significant difference with the patients’ age.
 Conclusion: This study confers significant improvement of quality of life after valve surgery with time. Age does not appear to limit the quality of life. Family support seems to be the biggest strength in our population.

Health related quality of life of patients following mechanical valve replacement surgery for rheumatic mitral stenosis in Tanzania

“…Our findings are similar to those reported in other studies, showing that age does not effect HRQoL after cardiac surgery [ 39 , 47 ]. A study in Nepal concluded that the amount of HRQoL improvement gained by the elderly after heart valve surgery is similar to that of the young [ 39 ]. Similarly, Sedrakyan et al [ 47 ] found that among patients who have undergone heart valve surgery, age does not limit the HRQoL advantages of surgery.…”

“…There was a statistically significant improvement in the mean (±SD) MacNew global scores from 3.47 ± 0.59, 4.88 ± 0.71 and 6.14 ± 0.50 preoperatively, at 3 months and 6 months respectively. Our findings are in keeping with those reported in a study done in Nepal, South Asia which showed improvement in all domains of quality of life after valve replacement for RHD [ 39 ]. Similarly, in another study done in Fiji, an improvement was observed in all HRQoL domains except for mental health.…”

“…This could probably partly be explained by the observation that regardless of age, most of our patients had no comorbidities such as hypertension, diabetes, and infectious diseases which presumably could affect HRQoL. Our findings are similar to those reported in other studies, showing that age does not effect HRQoL after cardiac surgery [ 39 , 47 ]. A study in Nepal concluded that the amount of HRQoL improvement gained by the elderly after heart valve surgery is similar to that of the young [ 39 ].…”

“…Our findings are similar to that reported in a study done by Mangnall et al [ 10 ] which showed that preoperatively all mean HRQoL eight domains scores were much lower than the reference population with severe impairment in the general health and physical function domains. Similarly, Joshi et al [ 39 ] reported that the HRQoL was impaired in all eight domains with the lowest scores in the general health and physical function domain before surgery (15.61 ± 1.30), which improved after surgery (22.95 ± 0.45). In RHD, as valve damage progresses, the consequences for the affected patients are devastating in terms of morbidity and mortality as well as poor quality of life [ 11 , 40 ].…”

“…Noteworthy, the observed differences between these studies could be attributed to the differences in sample size, the studied populations and the difference in the PROMs used to assess HRQoL. For example, while our study and another [ 39 ] recruited patients with RHD, other studies [ 47 , 48 ] recruited patients with degenerative valve diseases.…”