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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Factors associated with poor self-reported health status after aortic valve replacement with or without concomitant
Kjersti Oterhals1, Tove Aminda Hanssen2, Rune Haaverstad3
1Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway kjersti.oterhals@helse-bergen.no.
Insights
Patients undergoing aortic valve replacement (AVR) report poorer physical and mental health compared to the general population. Key factors influencing health include social support, education, and mental health conditions like anxiety and depression.
Area of Science:
- Cardiovascular Surgery
- Patient-Reported Outcomes
- Health Status Assessment
Background:
- Improving patient health status is a primary objective in cardiac surgery.
- Limited understanding exists regarding factors influencing long-term self-reported health after aortic valve replacement (AVR), especially concerning concomitant coronary artery bypass grafting (CABG).
Purpose of the Study:
- To identify factors affecting self-reported health status up to 13 years post-AVR.
- To compare the health of AVR patients with the age- and gender-matched general population.
Main Methods:
- A survey questionnaire was administered to 1191 AVR patients (with or without CABG) between 2000-2012.
- Hierarchical linear regression analyzed Short Form 12 physical and mental scores against 34 independent variables, including the Minnesota Living with Heart Failure Questionnaire (MLHFQ).
- Data were compared with the Norwegian general population, with clinical data sourced from a cardiac surgery database.
Main Results:
- 912 patients (77% response rate) with a mean age of 73 years participated; 59% had isolated AVR.
- Predictors of worse physical health included low education, higher preoperative EuroSCORE, high NYHA class, depression, worse MLHFQ scores, arthritis, osteoporosis, and cancer.
- Poor mental health was associated with living alone, anxiety, depression, and worse MLHFQ emotional scores.
- AVR patients exhibited poorer physical and mental health than the general population, particularly older individuals.
Conclusions:
- Aortic valve replacement patients consistently report worse physical and mental health compared to the general population.
- Significant predictors of health status include social factors (living alone, education), physical symptoms, and psychological conditions (anxiety, depression).
- Enhanced screening for psychosocial risk factors and tailored rehabilitation programs are recommended to improve post-AVR patient outcomes.
Objectives:
Improving patients' health status is a central goal for cardiac surgery. Knowledge remains sparse on how combined CABG or other factors influence long-term, self-reported health status after aortic valve replacement (AVR). The aims of this study were (i) to identify significant factors influencing self-reported health status of patients assessed up to 13 years after AVR; and (ii) to compare their health with the age- and gender-matched general population.
Methods:
A survey questionnaire was sent to 1191 patients who had undergone AVR with or without concomitant CABG between 2000 and 2012. Physical and mental sum scores of Short Form 12 were used as dependent variables and 34 independent variables including the Minnesota living with Heart Failure Questionnaire (MLHFQ) were evaluated by hierarchical linear regression. A comparison was made with the Norwegian general population. Clinical data were obtained from the local cardiac surgery database.
Results:
In all, 912 patients (77%) responded (mean age: 73 years; 63% men). Of these, 59% had an isolated AVR. The mean assessment interval since surgery was 6 years. Several factors significantly predicted worse physical health: low education level (b: -2.8, P = 0.005), higher preoperative EuroSCORE (b: -0.88, P = 0.007), high NYHA class (b: -4.5, P < 0.001), depression (b: -5.62, P = 0.012), worse MLHFQ physical scores (b: -0.70, P < 0.001), arthritis (b: -5.13, P = 0.003), osteoporosis (b: -6.96, P = 0.010) and cancer (b: -4.48, P = 0.047) accounting for 60% of the variation (P < 0.001). Living alone (b: -3.60, P < 0.001), anxiety (b: -12.99, P < 0.001), depression (b: -6.82, P < 0.001) and worse MLHFQ emotional score (b: -0.50, P < 0.001) predicted poor mental health status, and explained 58% of the variation among AVR patients (P < 0.001). Both genders had poorer physical and mental health than their age-matched general population peers, particularly those in older age groups.
Conclusions:
AVR patients, regardless of gender, had worse physical and mental health than the general population. Living alone, educational level, physical symptom status, anxiety and depression were the most important predictors of physical and mental health status after AVR. Implementing new screening protocols for psychosocial risk factors and individualized rehabilitation programmes may contribute to improved health in AVR patients.
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