The influence of general health status and social support on symptomatic outcome following coronary artery bypass grafting

G M Lindsay, L N Smith, P Hanlon, D J Wheatley, G M Lindsay, L N Smith, P Hanlon, D J Wheatley

Abstract

Objectives: To assess health status, level of social support, and presence of coronary artery disease risk factors before and after coronary artery bypass grafting (CABG); to assess symptomatic relief approximately 12 months postoperatively; and to examine the association between preoperative health status and recurrence of symptoms.

Design: Observational study.

Setting: Preoperatively, in hospital outpatient department (1995-1996); postoperatively, at home (1996-97).

Subjects and methods: Patients awaiting elective CABG were recruited one month before the expected date of operation. Preoperative assessment included severity of symptoms, coronary artery disease risk factors, short form 36 (SF-36) questionnaire, and social activities questionnaire. The presence and severity of angina and breathlessness were reported postoperatively (mean 16.4 months). Multiple regression analysis was used to identify factors associated with improved outcome following CABG.

Main outcome measure: Patient reported presence and severity of angina and breathlessness.

Results: 183 patients were followed for a mean of 16. 4 months after CABG. Angina and breathlessness were completely relieved in 55% and 36% of patients, respectively. In patients with residual symptoms, the severity was significantly reduced (angina p < 0.001; breathlessness, p = 0.02). Patients with low SF-36 scores and low social network scores preoperatively were less likely to be relieved of symptoms (p < 0.001). Health status and social support levels preoperatively were lower than in other reported coronary artery disease patients groups. Preoperatively, coronary artery disease risk factors were higher than recommended in current guidelines: 67.4% had raised plasma cholesterol, 39.0% were hypertensive, 80% were moderately obese, and 22.9% were smokers.

Conclusions: Recurrence of symptoms exceeded other published studies. Patients' perception of general health, symptoms, and social support influences outcome.

Figures

Figure 1
Figure 1
Breakdown (%) of the numbers of grafts inserted at coronary artery bypass grafting in the study patients.
Figure 2
Figure 2
Box and whisker plot of SF-36 health survey scores for the eight health domains, showing median, interquartile range, and total range of scores.

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