Does cardiac surgery improve quality of life for older patients?

Abstract

Population ageing has resulted in cardiovascular disease becoming endemic in our rapidly growing population of older adults. Cardiac surgery for older patients has been well researched and found to be relatively safe, with acceptable outcomes. Little is known, from the patient’s perspective, about the impact of cardiac surgery on health related quality of life (HRQOL). There are currently no studies that have measured HRQOL of older patients after cardiac surgery in the New Zealand setting. Methods An integrative review of the literature identified research that has been conducted regarding HRQOL in the first 12 months after cardiac surgery for patients aged ≥ 70 years. Studies of interest were those that used a validated generic instrument to measure HRQOL before and after surgery, in patients over 70 years of age. This was a single centre, prospective, observational study of patients aged ≥ 75 years who underwent elective or urgent cardiac surgery at Auckland City Hospital (ACH). The SF-12 survey was utilised to measure patients’ HRQOL before and 12 weeks after cardiac surgery. Domain and summary scores were analysed to determine any difference between mean scores at the two measured time points. Physical and mental summary scores were compared to scores from an age matched ‘normal’ population. Data was analysed using standard parametric testing. Results Integrative literature review results Nineteen studies were reviewed. Results showed older patients undergoing cardiac surgery are most impaired preoperatively in physical domains of health, and it is physical domains that show most improvement postoperatively. Mental health domain scores are typically in a normal range at baseline and inclined to show less significant improvement postoperatively. Patients are more likely to report improved HRQOL in domains most impaired preoperatively. Study findings Significant improvement was found in all SF-12 domains: Physical Functioning (p= <0.00001), Role Physical (p= <0.0001), Bodily Pain (p= 0.002), General Health (p= 0.009), Vitality (p= 0.001), Social Functioning (p= <0.0001), Role Emotional (p= 0.0003), Mental Health (p= 0.0014). Both summary scores improved at 12 weeks: Physical Composite Score (PCS) (p= <0.0001), Mental Composite Score (MCS) (p= 0.001). Mean PCS scores were below population norms at baseline (40.7, standard deviation 9.2) and mean MCS scores were within normal range (49.4, standard deviation 10.5). By 12 weeks postoperatively the number of patients with a PCS ‘at’ or ‘above’ population norms improved from 39% to 68%. Patients whose MCS scores were ‘at’ or ‘above’ population norms improved from 68% to 90%. Conclusions Cardiac surgery in selected older patients is associated with significantly improved physical and mental HRQOL at 12 weeks postoperatively, compared to baseline.