OBJECTIVES: Neuropsychologic assessment after coronary artery bypass graft surgery indicates cognitive deficits, but data on their effect on health-related quality of life are relatively sparse. The present study assessed neuropsychologic deficits, self-reported health-related quality of life, and mood, together with proxy rating of patients' activities after bypass surgery. More specifically, the study examines the relationship between these varied outcome measures. METHODS: A prospective longitudinal assessment of 71 male patients was performed over a 6-month period: 1 week before surgery and postoperatively at 2 and 6 months. Within-patient change was assessed with the neuropsychologic test battery and procedures recommended by the Consensus Panel, the Short Form-36 to measure self-reported health-related quality of life, and the Hospital Anxiety and Depression Scale questionnaire to assess anxiety and depression. Proxy ratings were documented with the Functional Activities Questionnaire. RESULTS: Poor preoperative health-related quality of life was largely unrelated to medical variables. Cognitive deficit was found in 42% of patients at 2 months and 22% of patients at 6 months. Physical health-related quality of life improved, but benefit for emotional and social functioning was unconvincing, especially over the short term. Although cognitive deficits were largely unrelated to Short Form-36 health-related quality of life, and only partially related to anxiety and depression, they were associated with proxy ratings of patient functioning. CONCLUSIONS: Physical health-related quality of life benefits were confirmed, but adverse cognitive change and only limited emotional benefit were evident after coronary artery bypass graft surgery. Perceived physical gains are unrelated to any cognitive deficit, but the latter correlated with the emotional status of the patient 6 months after surgery and are of concern to close relatives. These issues should be addressed in patient care.
OBJECTIVES: Neuropsychologic assessment after coronary artery bypass graft surgery indicates cognitive deficits, but data on their effect on health-related quality of life are relatively sparse. The present study assessed neuropsychologic deficits, self-reported health-related quality of life, and mood, together with proxy rating of patients' activities after bypass surgery. More specifically, the study examines the relationship between these varied outcome measures. METHODS: A prospective longitudinal assessment of 71 male patients was performed over a 6-month period: 1 week before surgery and postoperatively at 2 and 6 months. Within-patient change was assessed with the neuropsychologic test battery and procedures recommended by the Consensus Panel, the Short Form-36 to measure self-reported health-related quality of life, and the Hospital Anxiety and Depression Scale questionnaire to assess anxiety and depression. Proxy ratings were documented with the Functional Activities Questionnaire. RESULTS: Poor preoperative health-related quality of life was largely unrelated to medical variables. Cognitive deficit was found in 42% of patients at 2 months and 22% of patients at 6 months. Physical health-related quality of life improved, but benefit for emotional and social functioning was unconvincing, especially over the short term. Although cognitive deficits were largely unrelated to Short Form-36 health-related quality of life, and only partially related to anxiety and depression, they were associated with proxy ratings of patient functioning. CONCLUSIONS: Physical health-related quality of life benefits were confirmed, but adverse cognitive change and only limited emotional benefit were evident after coronary artery bypass graft surgery. Perceived physical gains are unrelated to any cognitive deficit, but the latter correlated with the emotional status of the patient 6 months after surgery and are of concern to close relatives. These issues should be addressed in patient care.
Authors: Kenneth E Covinsky; Feng Lin; Vera Bittner; Mark A Hlatky; Sara J Knight; Eric Vittinghoff Journal: J Gen Intern Med Date: 2008-06-24 Impact factor: 5.128
Authors: Michael R Le Grande; Peter C Elliott; Barbara M Murphy; Marian U C Worcester; Rosemary O Higgins; Christine S Ernest; Alan J Goble Journal: Health Qual Life Outcomes Date: 2006-08-13 Impact factor: 3.186