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eComment: Even the elderly post-CABG patients have a better HRQoL postoperatively

Cardiothoracic Surgery Department, University Hospital of Patras, 22500 Rion Patras, Greece

EuroSCORE predicts health-related quality of life after coronary artery bypass grafting

According to your excellent study, male patients under 75 years old and female patients under 70 years old, with good ventricular function and without other co-morbidity, might obtain the best prospect for better health-related quality of life (HRQoL) [1]. In fact, it is evident from Table 2 of your study, that while the mean age in the group of low-, and medium-risk was 59 and 69, respectively, in the high-risk group it was 75.6 years [1]. Despite this fact, clinical improvement was observed in 46.8% of low-risk patients, in 34.8% of medium-risk patients and in 33.3% of high-risk patients, respectively. However, the differences were not significant among the 3 study groups, even at 36 months. The above finding is important because several studies have reported that in elderly patients – in whom a higher comorbidity usually exists – an increased incidence of postoperative greater worry and depression has been observed [2], severe emotional problems, and therefore a worse HRQoL, at least for 12 months postoperatively [3]. Contrary to this, we have demonstrated in a small number of elderly patients (mean age 72.9) that at 12 months following the operation, 80.4% of patients experienced an improvement in their reported HRQoL, in spite of the fact that nearly one in two patients reported neuro-cognitive problems that were present at 12 months postoperatively [4]. Moreover, despite the high incidence of early postoperative complications (up to 66.6%), HRQoL was significantly improved at 4 months after the operation (P<0.001) and continued being improved to a lesser degree one year afterwards (P<0.001).

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1. Loponen P, Luther M, Nissinen J, Wistbacka JO, Biancari F, Laurikka J, Sintonen H, Tarkka MR. EuroSCORE predicts health-related quality of life after coronary artery bypass grafting. Interact CardioVasc Thorac Surg 2008;7:564–568.[Abstract/Free Full Text]
2. Khatri P, Babyak M, Clancy C, Davis R, Croughwell N, Newman M, Reves JG, Mark DB, Blumenthal JA. Perception of cognitive function in older adults following coronary artery bypass surgery. Health Psychol 1999;18:301–306.[CrossRef][Medline]
3. Herlitz J, Caidahl K, Wiklund I, Sjoland H, Karlson BW, Karlsson T, Haglid M, Hartford M. Impact of a history of diabetes on the improvement of symptoms and quality of life during 5 years after coronary artery bypass grafting. J Diabetes Complications 2000;14:314–321.[CrossRef][Medline]
4. Merkouris A, Apostolakis E, Pistolas D, Papagiannaki V, Diakomopoulou E, Patiraki E. Quality of life after coronary artery bypass graft surgery in the elderly. Eur J Cardiovascular Nursing 2008 Apr 17, [Epub ahead of print] PMID: 18424183 [PubMed – as supplied by publisher].

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