title: Assessment of decline in health-related quality of life among angina-free patients undergoing coronary artery bypass graft surgery.
abstract: OBJECTIVE
  Coronary artery bypass graft (CABG) surgery generally decreases symptoms and improves quality of life, but for those patients without angina, prolongation of life takes precedence. We used the SF-36 to assess changes in health-related quality of life (HRQOL) among patients who were angina free prior to CABG compared to those reporting angina.
  
  
  METHODS
  We combined data from two randomized trials of hemodynamic management during surgery. Prior to CABG, demographic, clinical and SF-36 data were obtained. Patients were reevaluated at a 6-month follow-up. Patients with a decline of > or =15 points from baseline to follow-up for individual SF-36 domains and >5 points for summary components were classified as having a decline. We used logistic regression models that controlled for baseline SF-36 score and other baseline characteristics to assess HRQOL decline with respect to angina status.
  
  
  RESULTS
  Of 590 patients, 28% were angina free at baseline. A third of the patients angina free at baseline had a postoperative decline in physical function. Patients who were angina free at baseline were three times more likely to suffer a decline in physical function than those with angina (odds ratio 3.29, 95% confidence interval 1.86-5.82). This finding remained after addition of adverse outcomes to the model. Baseline angina status was not related to any other SF-36 domain or to physical or mental summary component scores. Major adverse outcomes did not differ between angina-free patients and those with angina.
  
  
  CONCLUSIONS
  The incidence of patients reporting a decline in physical function after CABG was greater in patients without angina preoperatively, even when adjusting for baseline score. Given the substantial risk of decreased physical functioning, employing interventions to maintain HRQOL in this population should be considered.
authors.affiliation: General Medicine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Mass., USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pirraglia
authors.forename: Janey C
authors.initials: JC
authors.lastname: Peterson
authors.forename: Pamela
authors.initials: P
authors.lastname: Williams-Russo
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlson
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D011336:Probability; D011788:Quality of Life; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D016896:Treatment Outcome