QOL-associated factors in elderly patients who underwent cardiovascular surgery

Environmental Health and Preventive Medicine, Aug 2011

Kiyoko Terashima, Yoko Yoshimura, Kazuyoshi Hirai, Yukinori Kusaka

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QOL-associated factors in elderly patients who underwent cardiovascular surgery

Environ Health Prev Med QOL-associated factors in elderly patients who underwent cardiovascular surgery Kiyoko Terashima 0 1 Yoko Yoshimura 0 1 Kazuyoshi Hirai 0 1 Yukinori Kusaka 0 1 0 K. Hirai Y. Kusaka Department of Environmental Health, School of Medicine, University of Fukui , 23-3 Shomoaitsuki, Matsuoka, Eiheizi-cho, Fukui 910-1193 , Japan 1 K. Terashima (&) Y. Yoshimura Faculty of Nursing and Social Welfare Sciences, Fukui Prefecture University , 4-1-1 Kenzyozima, Matsuoka, Eiheizi-cho, Fukui 910-1195 , Japan Objectives Quality of life (QOL) was compared between elderly patients treated with cardiac surgery (cardiac surgery group) and general elderly nonoperated individuals (control group) to clarify differences in QOL-associated factors between the two groups. Methods The cardiac surgery group consisted of 82 patients aged 72.5 years at approximately 2 years after discharge, and the control group consisted of 95 elderly individuals aged 77 years living at home. QOL was measured based on interviews using two scales: disease-specific QOL and Short Form (36) Health Survey (SF-36) in the cardiac surgery group, and SF-36 in the control group. Associated factors included the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence, living with one's spouse, exercise habit, and the number of past medical history items. Results There was no cardiac surgery procedure-associated significant difference in disease-specific QOL. When comparing SF-36 between groups, the physical health level was significantly lower in the cardiac surgery group, but no significant difference was noted in the mental health level. Regarding physical health level of SF-36-associated factors, mental health level was a negative factor in both groups. In the cardiac surgery group, age was a negative factor. In the control group, the TMIG index and number of past medical history items were positive and negative factors, respectively. Conclusions As elderly people with high physical health levels after cardiac surgeries may have low mental health levels, physicians and nurses need to be aware and address this situation. Cardiovascular surgery; Disease-specific; QOL; SF-36; TMIG index of competence; Comparison study Introduction The mortality rate from chronic diseases has increased with the aging of society, and the number of deaths from heart diseases in 2006 in Japan was 173,125, accounting for 16.0% of all deaths. Mortality rates (per 100,000 persons) from ischemic heart disease in men and women were 68.1% and 53.5%, respectively, accounting for 44.3% of all deaths from heart diseases [ 1 ]. The number of surgeries performed in the cardiac surgery field has been increasing over the years, from 20,000 in the late 1980s to 54,000 in 2006, and surgeries for ischemic heart disease accounted for about one third of all cardiac surgeries. According to a survey performed by the Japanese Association for Coronary Artery Surgery, coronary artery bypass grafting (CABG) was performed in 14,583 cases at 319 facilities nationwide in 2007, and an off-pump procedure using a nopump oxygenator, established as the standard CABG procedure, was employed in more than 60%, [ 2 ], indicating that low-invasive cardiovascular surgery has been rapidly spreading and the number of aging patients undergoing surgery will further increase. However, surgery of ‘‘the heart,’’ an organ that strongly symbolizes life, may have a marked psychological influence on elderly patients. Moreover, elderly people’s conditions become complicated by the impairment of motor organs with aging, which makes it difficult to maintain activity during the postoperative process of discontinuing bed rest and after discharge. Therefore, the quality of life (QOL) of elderly patients following cardiac surgery may be influenced by many factors in a complex way in addition to the physical stress of surgery. The purpose of cardiovascular surgeries has changed to improved QOL from simply treatment and prolongation of life; for this purpose, QOL has been actively investigated [ 3–10 ]. However, most studies evaluate surgical indications based on the New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) survival rate before and after surgery, the effect and treatment, and intervention employing a QOL scale only from viewpoints of health care workers. Cardiac surgery improves survival rate and symptoms and improves QOL in many reports [11], but there have been fewer reports on QOL evaluation from viewpoints of the elderly patients themselves, such as whether they found pleasure in and realized the significance of their own social roles. In this study, participants were elderly patients at approximately 2 years after CABG, valve replacement, or aortic/thoracic aortic bypass grafting at the same medical institution who were relatively healthy and could continue outpatient visits. The time required after cardiac surgery to recover their preoperative QOL leve (...truncated)


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Kiyoko Terashima, Yoko Yoshimura, Kazuyoshi Hirai, Yukinori Kusaka. QOL-associated factors in elderly patients who underwent cardiovascular surgery, Environmental Health and Preventive Medicine, 2011, pp. 131-138, Volume 17, Issue 2, DOI: 10.1007/s12199-011-0230-1