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Psychosocial outcome one year after heart surgery. A prospective study
Insights
Cardiac surgery patients showed good physical recovery, but 25% experienced poor psychosocial adjustment one year post-operation. Pre-existing psychological distress and specific illness behaviors predicted negative psychosocial outcomes, independent of surgical success.
Area of Science:
- Cardiology
- Psychology
- Health Outcomes Research
Background:
- Cardiac surgery, including valve replacement and coronary artery bypass grafting, significantly impacts patients' physical and psychological well-being.
- Assessing long-term psychosocial adjustment is crucial for comprehensive patient care after major cardiac procedures.
Purpose of the Study:
- To evaluate the physical and psychosocial outcomes of patients one year after cardiac surgery.
- To identify preoperative predictors of poor psychosocial adjustment following cardiac interventions.
Main Methods:
- A cohort of 99 patients undergoing cardiac valve replacement or coronary artery bypass grafting were assessed preoperatively and one year postoperatively.
- Psychological, social, and physical variables were measured using validated questionnaires, including the Illness Behavior Questionnaire and Symptom Distress Checklist.
- Medical data from non-returning patients were obtained from general practitioners.
Main Results:
- Over 90% of patients demonstrated physical improvement after surgery.
- While mean scores for psychological distress and quality of life improved, approximately 25% of patients exhibited poor psychosocial adjustment at follow-up.
- Poor psychosocial adjustment was not associated with the surgical outcomes.
- Preoperative factors such as high scores on hypochondriasis and irritability subscales, elevated anxiety and depression, and ischemic heart disease predicted adverse psychosocial outcomes.
Conclusions:
- Cardiac surgery yields significant physical benefits, but a substantial minority of patients face long-term psychosocial challenges.
- Preoperative psychological status and specific illness behaviors are critical indicators for identifying patients at risk for poor psychosocial adjustment.
- Interventions targeting psychological distress and illness behaviors pre-surgery may improve long-term psychosocial well-being in cardiac patients.
Abstract:
Ninety-nine of 118 patients receiving cardiac valve replacements (n = 55) or coronary artery bypass grafts (n = 44) were studied before surgery and again one year after surgery. Psychological, social, and physical variables were assessed. For the 19 subjects not returning for follow-up, medical data collected by their general practitioner were available. The physical results of surgery were good, with over 90% of the patients showing improvement. Mean scores for psychological distress and quality of life improved; however, a bad psychosocial adjustment was present in about 25% of patients at follow-up. Bad psychosocial adjustment was not correlated with surgical results. The preoperative variables most predictive of poor psychosocial outcome were high scores in the general hypochondriasis and irritability subscales of the illness Behaviour Questionnaire, bad psychological adjustment characterized by high anxiety, depression, and global scores on the Symptom Distress Checklist, and ischemic rather than valvular heart disease.