Advertisement

Quality of Life Research

, Volume 1, Issue 3, pp 177–185 | Cite as

Clinical outcome and emotional-behavioural status after isolated coronary surgery

  • P. Pinna Pintor
  • R. Torta
  • S. Bartolozzi
  • R. Borio
  • E. Caruzzo
  • A. Cicolin
  • M. Giammaria
  • F. Mariani
  • G. Ravarino
  • F. Triumbari
  • O. Alfieri
  • L. Ravizza
Research Paper

Abstract

In order to evaluate clinical and psychosocial results of isolated coronary artery by-pass graft (CABG) we studied 626 consecutive patients, mean age 61±8 years (86% men), in a follow-up (median: 58 months) with a complete questionnaire about cardiosurgical problems (post-operative vital status, angine relapse, infarction, heart failure, PTCA, redo, PM) and psychosocial variables (mood, irritableness, job satisfaction, hobby satisfaction, family relations, sexual activity, general well-being and work status). Global evaluation improvement of psychosocial variables was found in 71% of patients without cardiac events (group A) and 11% of patients with cardiac events (group B); worsening was found in 2% of group A and 1% of group B; no referred variations in 13% and 2% respectively (p≤0.05. Interests (in work, hobbies and sexual activities) demonstrate an improvement in 20% (group A) and 2% (group B); worsening in 12% (group A) and 4% (group B); no variations in 51% (group A) and 11% (group B) (p≤0.005). Patients reported a well-being evaluation improvement about 66% in the group returning to work without restriction, 13% in those with limitation, 6% no further working; worse or unchanged well-being evaluation was found in 9% of patients returning to work without restriction, 3% with limitation, 3% no further working (p≤0.001). In the last 2 years we have collected pre-operative and post-operative data in a sample of 58 patients by using standardized self-evaluated rating scales about state and trait anxiety (STAI X1, STAI X2), depression (ZUNG) and quality of life, examining social relationships, interests and affective disturbances. Trait anxiety had no change (T0=38.69±9.20 vs. T1=38.75±9.90; n.s.); state anxiety improved (T0=41.20±9.30 vs. T1=38.34±9.68;p≤0.018); depression had significantly worsened (T0=37.90±7.59 vs. T1=46.65±4.75;p≤0.0005). No statistical differences emerged between pre-operative and post-operative self-evaluation of the quality of life. Cardiac events were reported in 7 out of 58 patients (group B: 12%); these patients were characterized by significantly higher levels of state anxiety than group A patients at the pre-operative evaluation (group A: 39.9±8.2; group B: 49.6±11.8;t=0.933; df=56;p≤0.005) and at the post-operative evaluations (group A: 36.7±8.4; group B: 48.7±11.4;t=−3.6; df=56;p≤0.001). The trait anxiety was significantly lower at the postoperative control in the group A patients than in the group B (group A: 37.5±9.3; group B: 46.9±10.5;t=−2.602; df=56;p≤0.012). The pre-operative depression of group B was higher than group A (group A: 37.1±7.6; group B: 43.1±5.5;t=−2.155; df=56;p≤0.035). The discordance between the improvement of subjective global evaluation versus the worsening of depression (ZUNG Scale) can be related to the importance of physical improvement as much as to some psychosocial variables. Further hypotheses can be represented by the influence of a short pre-operative period in our institution (maximum 30 days) on anxiety and depression levels, the difference between pre-surgical and post-surgical expectations, the removal of pre-operative psychological state; the stress related to psychosocial reintegration etc. In our opinion, taking into consideration the results of the sample of 58 patients, a high level of pre-operative state anxiety and depression and a post-operative higher status of anxiety could be considered as a possible predictor of functional cardiac complications.

Key words

Anxiety CABG clinical outcome depression quality of life 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Rogers WJ, Coggin CJ, Gersh BJ, Fisher DL, Myers WO, Oberman A, Sheffield LT. Ten-year follow-up of quality of life in patients randomized to receive medical therapy or coronary artery bypass graft surgery.Circulation 1990;82: 1647–1658.Google Scholar
  2. 2.
    Booth DC, Deupree RH, Hultgren HN, De Maria AN, Scott SM, Luchi RJ and the Investigators of Veterans Affairs Cooperative Study No. 28. Quality of life after bypass surgery for unstable angina. 5-years follow-up results of a Veterans Affairs Cooperative Study.Circulation 1991;83: 87–95.Google Scholar
  3. 3.
    Peduzzi P, Hultgren H, Thomsen J, Detre K. Ten-year effect of medical and surgical therapy on quality of life: Veterans Administration Cooperative Study of Coronary Artery Surgery.Am J Cardiol 1987;59: 1017–1023.Google Scholar
  4. 4.
    Sergeant P. Quality of life after open heart surgery expressed as the postCABG return of clinical ischemic symptoms. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 11.Google Scholar
  5. 5.
    Thulin LI. Aspects of quality of life in patients with mechanical heart valves. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 10.Google Scholar
  6. 6.
    Hirnle T, Stupinski W, Loboz-Grudzien K, Arendarczyk M. Quality of life following coronary bypass surgery. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 24P.Google Scholar
  7. 7.
    Cay EL, O'Rourke A. The emotional state of patients after coronary by-pass surgery. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 18.Google Scholar
  8. 8.
    Langosch W, Schmoll-Flockerzie HP. Psychological reactions to open heart surgery: results of a quantitative and qualitative analysis of the recovering process. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 20.Google Scholar
  9. 9.
    Heller SD, Frank KA, Kornfeld DS, Malm FO Jr. Psychological outcome following open-heart surgery.Arch Intern Med 1974;134: p. 908.Google Scholar
  10. 10.
    Torta R, Maina G, Ravarino G, Zanalda E, Bartolozzi S, Coletti V, Alfieri O, Ravizza L, Pinna Pintor P. Preoperating evaluation of state and trait anxiety in cardiosurgical patients. Abstract of International Meeting on Mental Stress as a Trigger of Cardiovascular Events. Veruno, Italy. October 1989, p. 17.Google Scholar
  11. 11.
    Blachly PH, Blachly BJ. Vocational and emotional status of 263 patients after heart surgery.Circulation 1968;38: 524.Google Scholar
  12. 12.
    Frank KA, Heller SS, Kornfeld DS. A survey of adjustment to cardiac surgery.Arch Intern Med 1972;130: p. 735.Google Scholar
  13. 13.
    Marechal MC. Etude des consequences psychologiques à long-terme des prothèses valvulaires.Arch Mal Coeur 1979;72: 440–444.Google Scholar
  14. 14.
    Zyzanaski SJ, Stanton TSA, Jenkins CD. Medical and psychosocial outcome in survivors of major heart surgery.J Psychosom Res 1981;23: 213–221.Google Scholar
  15. 15.
    Horgan D, Davies B, Hunt D. Psychiatric aspects of coronary artery surgery: a prospective study.Med J Aust 1984;141: 587–590.Google Scholar
  16. 16.
    Perski A, Odlund SG, Rehnqvist N, Theorell T. The quality of life one year after by-pass operation. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991; p. 28P.Google Scholar
  17. 17.
    Mayou R. The clinical significance of research on the psychosocial outcome of coronary by-pass surgery. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991; p. 19.Google Scholar
  18. 18.
    Lucia W, McGuire LB. Rehabilitation and functional status after surgery for valvular heart disease.Archs Intern Med 1970;126: p. 995.Google Scholar
  19. 19.
    Ross JK, Diwel AE, Marsh J. Wessex cardiac surgery follow-up surgery: a quality of life after operation.Thorax 1978;33: 3–10.Google Scholar
  20. 20.
    Jenkins CD, Stanton BA, Savageau JA, Denlinger P, Klein MD. Coronary artery by-pass surgery. JAMA 1983;250(6): 782–788.Google Scholar
  21. 21.
    Boudrez H, Denolet J, Amsel BJ, De Backer G, Walter PJ. Quality of life after open heart surgery. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 17.Google Scholar
  22. 22.
    Caine N, Harrison SCW, Sharples LD, Wallwork J. A prospective study of quality of life before and after coronary artery bypass grafting. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 7P.Google Scholar
  23. 23.
    Stanton BA, Jenkins CD, Savageau JA, Thurer RL. Functional benefits following coronary artery bypass graft surgery.Ann Thorac Surg 1984;37(4): 286–290.Google Scholar
  24. 24.
    Stanton Newman D. Perceived and assessed cognitive function following coronary artery by-pass graft surgery. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 16.Google Scholar
  25. 25.
    Jenkins CD. Psychosocial states of patients after heart valve replacement. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 7.Google Scholar
  26. 26.
    Magni G, Unger HP, Valfré C, Polesel E, Cesari F, Rizzardo R, Paruzzolo P, Gallucci B. Psychosocial outcome one year after heart surgery.Arch Intern Med 1987;147: 473–477.Google Scholar
  27. 27.
    Walter PJ, Ibe B, Gottwik M. Return to work after CABS in comparison to heart valve replacement. In: Walter PJ, ed. Return to work after coronary artery bypass surgery. Psychosocial and economic aspects. Berlin, Heidelberg: Springer Verlag, 1985: 125–133.Google Scholar
  28. 28.
    Walter PJ. Return to work after coronary artery bypass surgery. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 21.Google Scholar
  29. 29.
    Mattlar CE, Engblom E, Vesala P, Carlsson A, Vänttinen E, Puukka P. Conscious depression and anxiety associated with CABS. A 30 months follow-up study. Abstracts of International Symposium on Quality of Life after Open Heart Surgery. Antwerp, May 1991: p. 25P.Google Scholar

Copyright information

© Rapid Communications of Oxford Ltd 1992

Authors and Affiliations

  • P. Pinna Pintor
    • 1
  • R. Torta
    • 2
  • S. Bartolozzi
    • 1
  • R. Borio
    • 2
  • E. Caruzzo
    • 1
  • A. Cicolin
    • 2
  • M. Giammaria
    • 1
  • F. Mariani
    • 1
  • G. Ravarino
    • 1
  • F. Triumbari
    • 1
  • O. Alfieri
    • 1
  • L. Ravizza
    • 2
  1. 1.Fondazione Arturo Pinna PintorTorinoItaly
  2. 2.Istituto di Clinica PsichiatricaUniversità di TorinoItaly

Personalised recommendations