Abstract
Objective
Heart disease is the leading cause of death for women. Previous studies suggest that women undergoing coronary artery bypass (CABG) surgery present with a higher severity of disease and that this may be an indicator of delays in treatment preceding diagnosis thus presenting challenges for recovery. The aim of this study was to examine gender differences in CABG morbidity and reported health-related quality of life (HRQL) at baseline and six months post-surgery. It was hypothesized that female gender would be an independent predictor for lower HRQL at six months following CABG surgery.
Methods
Four hundred and ninety-six (n = 496) adult patients who underwent a first-time, isolated CABG procedure with baseline and 6-month follow-up were included. Stepwise multivariate regressions were conducted to evaluate the factors predictive of 6-month HRQL scores.
Results
Females had more preoperative co-morbidities and scored significantly lower on HRQL compared to males at both baseline ( p values < 0.01) and six months ( p values < 0.01) on all ten domains. Gender was a significant predictor of 6-month HRQL in regression models for 8 out of 10 HRQL domains including Physical Component Summary score (B = − 2.54, p = 0.02).
Conclusions
Female patients were at higher risk as reflected by their perioperative risk factors and baseline HRQL. These findings may reflect a delayed referral for surgery. Results indicated that female gender predicts lower HRQL 6-months post-CABG surgery, which can have an impact on recovery and outcomes. Efforts should be made to identify and treat female patients earlier to improve post-surgical outcomes.
1
Introduction
Heart disease is the leading cause of death for women and has become an area of particular focus for research in recent years . An understanding of the potential impact of gender on the risks and management of cardiovascular disease is paramount to addressing gender related differences in the approach to diagnostic testing and treatment practices that may have an effect on outcomes. Previous studies suggest that women undergoing a coronary artery bypass (CABG) procedure present to surgery with a higher severity of coronary artery disease, perhaps as a result of delays in recognizing and diagnosing the severity of their cardiovascular status . This higher severity of disease presents challenges for their recovery after cardiac surgery, especially with regard to health related quality of life (HRQL) .
Over the past decade, clinical registries specifically related to cardiac surgery have been developed. As a result, tracking and analysis of “hard” endpoints, including mortality and adverse events are being performed routinely. The Society of Thoracic Surgeons (STS) risk model recognizes gender when calculating predicted risk . These registries include private health care facilities and those organized at the institutional, state, and national level. A potential limitation of such data may be the deficiency in measuring HRQL and functional status despite the evidence that these outcomes are important and may lead to a better understanding of clinical course and improving patient outcomes following cardiac surgery .
The present study was part of a comprehensive research program focused on HRQL in cardiac surgery patients, which is important for better understanding the health trajectory of cardiac surgery patients both before and after surgical intervention. The aims of this study were: 1) To examine the association between gender and co-morbidities at the time of surgery; 2) To determine the independent predictors of HRQL scores at 6 months post-CABG surgery. It was hypothesized that female gender would be identified as an independent predictor for lower health-related quality of life scores at six months following CABG as compared to males.
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