Health related quality of life trajectories and predictors following coronary artery bypass surgery.
BACKGROUND
Many studies have demonstrated that health related quality of life (HRQoL) improves, on average, after coronary artery bypass graft surgery (CABGS). However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS.


METHODS
182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36), Profile of Mood States (POMS) and the Everyday Functioning Questionnaire (EFQ). These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL.


RESULTS
For both the physical component summary scale (PCS) and the mental component summary scale (MCS) of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified (improvers and non-improvers). A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non-improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class; for the MCS the most significant predictors of non-improver membership were higher scores on POMS depression-dejection and manual occupation.


CONCLUSIONS
It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of each patient, and those post-operative symptoms that could be possible targets for intervention to improve HRQoL outcomes.
Le Grande
Michael R
MR
Heart Research Centre Melbourne, Box 2137 Post Office, The Royal Melbourne Hospital, VIC 3050, Australia. michael.legrande@heartresearchcentre.org
Elliott
Peter C
PC
Murphy
Barbara M
BM
Worcester
Marian U C
MU
Higgins
Rosemary O
RO
Ernest
Christine S
CS
Goble
Alan J
AJ
D000203:Activities of Daily Living; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000523:psychology; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D011379:Prognosis; D011594:Psychometrics / Q000295:instrumentation; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014739:Victoria