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Published on: March 27, 2018
Changes in cardiac and cognitive function and self-reported outcomes at one year after coronary artery bypass
Lars Mathisen1, Per Snorre Lingaas, Marit Helen Andersen
1Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. lars.mathisen@medisin.uio.no
Insights
Individual outcomes after coronary artery bypass grafting (CABG) vary. Improvements in angina, exercise capacity, and cognitive function significantly impact physical and mental health one year post-surgery.
Area of Science:
- Cardiovascular Surgery
- Quality of Life Research
- Patient Outcomes
Background:
- Coronary artery bypass grafting (CABG) improves health at a group level, but individual patient outcomes vary significantly.
- Understanding factors influencing patient-reported health status post-CABG is crucial for effective patient counseling and care.
Purpose of the Study:
- To determine the relative importance of changes in cardiac function, cognitive function, and symptom status on physical and mental health outcomes one year after CABG.
- To identify key predictors of patient-reported health status following CABG surgery.
Main Methods:
- A cohort of 86 patients undergoing CABG was assessed.
- Multivariable regression analysis evaluated self-reported physical and mental health (SF-36) at 12 months, adjusting for baseline status.
- Independent variables included changes in exercise capacity, cognitive function, and angina symptom relief. Graft patency was assessed via angiography.
Main Results:
- Improvement in angina was linked to better physical health (beta = 0.23, P = .012).
- Increased exercise capacity explained 9% of the variance in physical health (beta = 0.42, P = .001).
- Enhanced cognitive function correlated significantly with improved mental health (beta = 0.52, P = .007), but not physical health.
Conclusions:
- Individual changes in functional performance and symptom relief are significant predictors of self-reported health status after CABG.
- These factors are important beyond preoperative health, sex, and graft patency.
- Acknowledging outcome variability is vital for pre- and post-operative patient counseling.
Objective:
Although health status after coronary artery bypass grafting improves at the group level, individual outcomes demonstrate variation. We aimed to evaluate relative importances of changes in cardiac and cognitive function and symptom status regarding physical and mental health at 1 year after coronary artery bypass grafting.
Methods:
Outcomes in multivariable regression analysis (n = 86) were self-reported physical and mental health (Medical Outcomes Study 36-Item Short Form) at 12 months' follow-up, adjusting for baseline. Independent variables were change in exercise capacity (staged ergometer protocol), cognitive function (neurocognitive test battery), and self-reported improvement of angina. Graft patency was evaluated by angiography (82/86 patients).
Results:
After surgery, health status was comparable to the age- and sex-matched population norm. Improvement of angina was associated with gain in physical health in the range of 0.5 SD (beta = 0.23, P = .012). Change in observed physical exercise capacity (mean +/- SD 199 +/- 426 W x min) accounted for 9% of variance in physical health (beta = 0.42, P = .001). Positive change in cognitive function was significantly related to mental (beta = 0.52, P = .007) but not physical health. Graft occlusion (22/82 patients) was not significantly related to health status.
Conclusions:
Individual variation in objective functional performance and symptom relief is significant for self-reported health status, beyond the predictive ability of preoperative health status, sex, and graft patency. Awareness of the extent and impact of outcome variation is important when counseling patients before and after coronary artery bypass grafting.
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