Anxiety and health-related quality of life after cardiac surgery

Yalcin Guzelhan, Murat Ugurlucan, Didem Melis Oztas, Metin Onur Beyaz, Orcun Unal, Nilufer Bektas, Cenk Conkbayir, Ufuk Alpagut, Nilgun Bozbuga, Yalcin Guzelhan, Murat Ugurlucan, Didem Melis Oztas, Metin Onur Beyaz, Orcun Unal, Nilufer Bektas, Cenk Conkbayir, Ufuk Alpagut, Nilgun Bozbuga

Abstract

Introduction: The aim of this study was to investigate the effect of elective cardiac surgery on health-related quality of life (HRQoL).

Material and methods: One hundred and eight (35 women and 73 men, mean age 62.3 ±12.7 years) patients undergoing open heart surgery were enrolled in the study. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire, and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 108 patients filled out the SF-36 and STAI, and 102 patients at 6-month follow-up.

Results: It was found that there was significant improvement in three out of eight health domains: physical functioning (p < 0.02), role physical (p < 0.01), and social functioning (p < 0.04), at 6-month follow-up. The two STAI sub-scores: the State Anxiety Inventory and the Trait Anxiety Inventory were found to be high (≥ 40) both preoperatively and 6 months postoperatively. Postoperatively there was not any statistically significant decrease in the levels of anxiety.

Conclusions: This study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status and HRQoL in patients after cardiovascular surgery. Furthermore, the assessment of preoperative well-being should be integrated in routine care in order to identify and support patients with higher levels of anxiety.

Keywords: anxiety; cardiac surgery; health-related quality of life; risk factors; short-form health survey; state-trait anxiety inventory.

Conflict of interest statement

The authors declare no conflict of interest.

Copyright: © 2020 Termedia & Banach.

References

    1. Shan L, Saxena A, McMahon R, Wilson A, Newcomb A. A systematic review on the quality of life benefits after aortic valve replacement in the elderly. J Thorac Cardiovasc Surg. 2013;145:1173–89.
    1. Jokinen JJ, Hippelainen MJ, Turpeinen AK, Pitkanen O, Hartikainen JE. Health related quality of life after coronary artery bypass grafting: a review of randomized controlled trials. J Card Surg. 2010;25:309–17.
    1. Noyez L, de Jager MJ, Markou AL. Quality of life after cardiac surgery: under researched research. Interact Cardiovasc Thorac Surg. 2011;13:511–4.
    1. Blumenthal JA, Lett HS, Babyak MA, et al. NORG Investigators. Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet. 2003;362:604–9.
    1. Abah U, Dunne M, Cook A, et al. Does quality of life improve in octogenarians following cardiac surgery? A systematic review. BMJ Open. 2015;5:e006904.
    1. Puskas JD, Williams WH, Mahoney EM, et al. Off-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA. 2004;291:1841–9.
    1. Jensen BØ, Hughes P, Rasmussen LS, Pedersen PU, Steinbruchel DA. Health-related quality of life following off-pump versus on-pump coronary artery bypass grafting in elderly moderate to high-risk patients: a randomized trial. Eur J Cardiothorac Surg. 2006;30:294–9.
    1. Krannich JH, Lueger S, Weyers P, Elert O. Health-related quality of life two days before, ten days and one year after coronary artery bypass graft surgery. Thorac Cardiovasc Surg. 2007;55:288–92.
    1. Viswanathan GN, Mayurathan G, Hildreth T, Worthley SG, Zaman AG. Health related quality of life after percutaneous coronary revascularisation in patients with previous coronary artery bypass grafts: a two-year follow up study. Appl Res Qual Life. 2011;6:311–24.
    1. Cohen DJ, Van Hout B, Serruys PW, et al. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery. N Engl J Med. 2011;364:1016–26.
    1. Middel B, El Baz N, Pedersen SS, van Dijk JP, Wynia K, Reijneveld SA. Decline in health-related quality of life 6 months after coronary artery bypass graft surgery: the influence of anxiety, depression, and personality traits. J Cardiovasc Nurs. 2014;29:544–54.
    1. Lie I, Arnesen H, Sandvik L, Hamilton G, Bunch EH. Health-related quality of life after coronary artery bypass grafting. The impact of a randomised controlled home based intervention program. Qual Life Res. 2009;18:201–7.
    1. Damgaard S, Lund JT, Lilleør NB, Perko MJ, Madsen JK, Steinbruchel DA. Comparably improved health-related quality of life after total arterial revascularization versus conventional coronary surgery Copenhagen arterial revascularization randomized patency and outcome trial. Eur J Cardiothorac Surg. 2011;39:478–83.
    1. WHO . Official records of the world health organization. Geneva: WHO; 1948.
    1. Constitution of the World Health Organization . Handbook of Basic Documents. 5th ed. Geneva: Palais des Nations; 1952. World Heath Organization; pp. 3–52.
    1. WHOQOL Group Study Protocol for the World Health Organisation project to develop a quality of life assessment instrument (WHOQOL) Qual Life Res. 1993;2:153–9.
    1. Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med. 1996;334:835–40.
    1. Wiebe S, Guyatt G, Weaver B, Matijevic S, Sidwell C. Comparative responsiveness of generic and specific quality-of life instruments. J Clin Epidemiol. 2003;56:52–60.
    1. Guyatt GH, Ferrans CE, Halyard MY, et al. Exploration of the value of health-related quality-of-life information from clinical research and into clinical practice. Mayo Clin Proc. 2007;82:1229–39.
    1. Ware JE, Kosinski M, Dewey JE. Changes between version 1 and version 2. In: Ware JE, Kosinski M, Dewey JE, editors. W: How to score version 2 of the SF-36 Health Survey (Standard and Acute forms) Lincoln: Quality Metric Incorporation; 2002.
    1. Ware JE, Sherbourne CD. The MOS 36-item short form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–83.
    1. Kiebzak GM, Pierson LM, Campbell M, Cook JW. Use of the SF-36 general health status survey to document health-related quality of life in patients with coronary artery disease: effect of disease and response to coronary artery bypass graft surgery. Heart Lung. 2002;31:207–13.
    1. Speilberger CG, Lushene R. State-Trait Anxiety Inventory Manual. Palo Alto, CA: Consulting Psychologists Press; 1970.
    1. Spielberger C. Manual for the State-Trait Anxiety Inventory (rev. ed.) Palo Alto (CA): Consulting Psychologists Press; 1983.
    1. Spielberger CD, Sydeman SJ, Owen AE, Marsh BJ. Measuring Anxiety and Anger with the State-Trait Anxiety Inventory (STAI) and the State-Trait Anger Expression Inventory (STAXI) In: Maruish ME, Mahwah NJ, editors. The Use of Psychological Testing for Treatment Planning and Outcomes Assessment. US: Lawrence Erlbaum Associates Publishers; 1999. pp. 993–1021.
    1. Aydemir Ö. Konsültasyon-Liyezon psikiyatrisinde yaşam kalitesi ölçümü: Kısa Form-36 (SF-36) Psikiyatri Psikoloji Psikofarmakoloji Dergisi; 1999.
    1. Newman MF, Grocott HP, Mathew JP, et al. Report of the substudy assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery. Stroke. 2001;32:2874–81.
    1. Colak Z, Segotic I, Uzun S, Mazar M, Ivancan V, Majeric- Kogler V. Health related quality of life following cardiac surgery correlation with EuroSCORE. Eur J Cardiothorac Surg. 2008;33:72–6.
    1. de Quadros AS, Lima TC, Rodrigues AP, et al. Quality of life and health status after percutaneous coronary intervention in stable angina patients: results from the real-world practice. Catheter Cardiovasc Interv. 2011;77:954–60.
    1. Li R, Yan BP, Dong M, et al. Quality of life after percutaneous coronary intervention in the elderly with acute coronary syndrome. Int J Cardiol. 2012;155:90–6.
    1. Soo Hoo SY, Gallagher R, Elliott D. Systematic review of health-related quality of life in older people following percutaneous coronary intervention. Nurs Health Sci. 2014;16:415–27.
    1. The WHOQOL Group . The Development of the World Health Organization Quality of Life Assessment Instrument (the WHOQOL) In: Orley J, Kuyken W, editors. Quality of Life Assessment: International Perspectives. Berlin, Heidelberg: Springer; 1994.
    1. The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;41:1403–9.
    1. Szabo S. The World Health Organization Quality of Life (WHOQOL) assessment instrument. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. Philadelphia: Lippincott-Raven Publishers; 1996. pp. 355–62.
    1. Prieto L, Alonso J, Ferrer M, Anto JM. Are results of the SF-36 health survey and the Nottingham Health Profile similar? A comparison in COPD patients. Quality of Life in COPD Study Group. J Clin Epidemiol. 1997;50:463–73.
    1. Lukkarinen H, Hentinen M. Assessment of quality of life with the Nottingham Health Profile among patients with coronary heart disease. J Adv Nurs. 1997;26:73–84.
    1. EuroQol – a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990;16:199–208.
    1. Failde I, Ramos I. Validity and reliability of the SF-36 Health Survey Questionnaire in patients with coronary artery disease. J Clin Epidemiol. 2000;53:359–65.
    1. Riegel B, Moser DK, Glaser D, et al. The Minnesota Living With Heart Failure Questionnaire: sensitivity to differences and responsiveness to intervention intensity in a clinical population. Nurs Res. 2002;51:209–18.
    1. Supino PG, Borer JS, Franciosa JA, et al. Acceptability and psychometric properties of the Minnesota Living With Heart Failure Questionnaire among patients undergoing heart valve surgery: validation and comparison with SF-36. J Card Fail. 2009;15:267–77.
    1. Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000;35:1245–55.
    1. Dixon T, Lim L, Oldridge NB. The MacNew health-related quality of life instrument: reference data for users. Qual Life Research. 2002;11:173–83.
    1. Hofer S, Lim LL, Guyatt G, Oldridge N. The MacNew Heart Disease Health-Related Quality of Life instrument: a summary. Health Qual of Life Outcomes. 2004;2:3.
    1. Spertus JA, Winder JA, Dewhurst TA, et al. Development and evaluation of the Seattle Angina Questionnaire: A new functional status measure for coronary artery disease. J Am Coll Cardiol. 1995;25:333–41.
    1. Dorian P, Mangat I. Quality of life variables in the selection of rate versus rhythm control in patients with atrial fibrillation: observations from the Canadian Trial of Atrial Fibrillation. Card Electrophysiol Rev. 2003;7:276–9.
    1. Calvert MJ, Freemantle N, Cleland JG. The impact of chronic heart failure on health-related quality of life data acquired in the baseline phase of the CARE-HF study. Eur J Heart Fail. 2005;7:243–51.
    1. Roberge M, Dupuis G, Marchland A. Post-traumatic stress disorder following myocardial infarction: prevalence and risk factors. Can J Cardiol. 2010;26:e170–5.
    1. Gjeilo KH, Wahba A, Klepstad P, Lydersen S, Stenseth R. The role of sex in health-related quality of life after cardiac surgery: a prospective study. Eur J Cardiovasc Prev Rehabil. 2008;15:448–52.
    1. Martin LM, Holmes SD, Henry LL, et al. Health-related quality of life after coronary artery bypass grafting surgery and the role of gender. Cardiovasc Revasc Med. 2012;13:321–7.
    1. Peric V, Borzanovic M, Stolic R, et al. Quality of life in patients related to gender differences before and after coronary artery bypass surgery. Interact Cardiovasc Thorac Surg. 2010;10:232–8.
    1. Skodova Z, van Dijk JP, Nagyova I, et al. Psychosocial predictors of change in quality of life in patients after coronary interventions. Heart Lung. 2011;40:331–9.
    1. Székely A, Balog P, Benkö E, et al. Anxiety predicts mortality and morbidity after coronary artery and valve surgery. A 4-year follow-up study. Psychosom Med. 2007;69:625–31.
    1. Graf J, Koch M, Dujardin R, Kersten A, Janssens U. Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. Crit Care Med. 2003;31:2163–9.
    1. Rosenbloom JI, Wellenius GA, Mukamal KJ, Mittleman MA. Self-reported anxiety and the risk of clinical events and atherosclerotic progression among patients with Coronary Artery Bypass Grafts (CABG) Am J Cardiol. 2009;158:867–73.
    1. Grös DF, Antony MM, Simms LJ, McCabe RE. Psychometric properties of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA): comparison to the State-Trait Anxiety Inventory (STAI) Psychol Assess. 2007;19:369–81.
    1. De Jong MJ, Hall LA. Measurement of anxiety for patients with cardiac disease: a critical review and analysis. J Cardiovasc Nurs. 2006;21:412–9.
    1. Greszta E, Siemińska MJ. Relationship of preoperative anxiety-state and anxiety-trait in patients qualified for coronary artery bypass graft surgery to the perception of postoperative pain and other pain complaints. Ann Acad Med Stetin. 2008;54:157–63.
    1. Rymaszewska J, Kiejna A, Hadrys T. Depression and anxiety in coronary artery bypass grafting patients. Eur Psychiatry. 2003;18:155–60.
    1. Wellenius GA, Mukamal KJ, Kulshreshtha A, et al. Depressive symptoms and the risk of atherosclerotic progression among patients with coronary artery bypass grafts. Circulation. 2008;117:2313–9.
    1. Güzelhan Y, Conkbayır C, Uğurlucan M, Yıldız CE, Alpagut U, Bozbuğa N. Gender differences in patients with anxiety after coronary artery bypass surgery. Heart Surg Forum. 2018;21:e165–9.

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