Return to work and quality of life measurement in coronary artery bypass grafting

Coronary bypass surgery (CABG) is effective in relieving angina and restoring expectation of life in patients with coronary artery disease. The aim of this work was to evaluate the effects of CABG on the quality of life (QL) and return to work (RW). Medical and non-medical variables influencing QL and RW were investigated. The results were compared with those of medically treated patients.

Five hundred fifty patients with chronic stable angina undergoing coronary angiography, were consecutively and prospectively enrolled in the study. Coronary lesions narrowing the lumen by more than 70% were considered significant. Questionnaire interviews were performed in hospital on admission and after at least 6 months follow-up. The QL interviews were based on quantitative evaluation of five conceptual dimensions: General Well-Being Schedule, Physical Symptoms Distress Index B, Sexual Satisfaction Unified Test, Social Participation and Work Performance and Satisfaction. Whether the patient had returned to work was recorded at each interview. Patients with significant coronary lesions were electively assigned to surgical (group A) or medical therapy (group B). The indications for surgical therapy were: triple-vessel disease, left main, ejection fraction (EF) less than 50%, angina resistant to medical therapy. Patients with non-significant coronary lesions, poor left ventricular function (EF < 25%) and combined valvular and coronary disease were excluded from the study. Patients scheduled for PTCA were also excluded.

Two hundred forty-six patients were assigned to group A, 200 to group B, 26 had non-significant coronary lesions, 16 combined valve and coronary disease, 15 poor left ventricular function and 78 were scheduled for PTCA. The mean follow-up for the two groups was 38 +/- 6 months. At in-hospital admission group A patients had overall worse QL perception, while at follow-up control the improvement in QL test was statistically significant. The group A mean RW rate was statistically significant, subgroup analysis showed a higher RW rate in patients without angina, working before surgery, under 50 years old, literate and with a professional or executive employment before surgery. At follow-up group B QL perception showed a positive trend, but not statistically significant. The group B RW rate was higher than that of group A, subgroup analysis did not show statistically significant data.

Our findings demonstrate that patients undergoing elective CABG surgery show early physical and psychological improvement. Specific rehabilitation programs can be useful in selected subgroups of patients.