PROSPECTIVE-STUDY OF QUALITY-OF-LIFE BEFORE AND AFTER OPEN-HEART OPERATIONS

Background. The aim of this prospective study, with completion of ques tionnaires before and 3 months after open heart operations, was to eva luate the improvement of quality of life brought about by these operat ions and the predictors of this improvement. Methods. The Nottingham h ealth profile questionnaire contains 38 subjective statements divided into six sections: energy, physical mobility, emotional reaction, pain , sleep, and social isolation. Factors influencing quality of life sco res were determined by analysis of covariance. Factors influencing the status of the patients (improved or worsened) were determined by logi stic regression. Results. From January to July 1994, 215 consecutive p atients underwent elective open heart operations. The comparison betwe en mean preoperative and postoperative scores showed an improvement in all sections of quality of life. An average of 80% of patients were i mproved by their operations. Independent predictors of less improvemen t of quality of life scores were as follows: for the energy section, a ge over 70 and New York Heart Association functional class III or IV; for sleep, age over 70; for physical mobility, New York Heart Associat ion functional class III or IV; for social isolation, female gender; a nd for pain, age over 70 and abnormal segmental wall motion. Independe nt predictors of patients worsened by operation were as follows: New Y ork Heart Association functional class III or IV in the energy section (odds ratio = 3.7, 95% confidence interval 1.4 to 9.8) and in the phy sical mobility section (odds ratio = 2.4, 95% confidence interval 1.02 to 5.5), female gender in the social isolation section (odds ratio = 2.8, 95% confidence interval 1.03 to 7.7), and presence of at least on e comorbid disease in the emotional reaction section (odds ratio 2.5, 95% confidence interval 1.17 to 5.2). Conclusions. Cardiac operations improve quality of life in patients. The improvement is similar for pa tients undergoing coronary artery bypass grafting versus valve replace ment, and for patients with no postoperative events versus those with nonlethal postoperative complications. The strongest predictive factor s for quality of life are age and New York Heart Association functiona l class.