title: Factors associated with poor self-reported health status after aortic valve replacement with or without concomitant bypass surgery.
abstract: OBJECTIVE
  Improving patients' health status is a central goal for cardiac surgery. Knowledge remains sparse on how combined CABG or other factors influence long-term, self-reported health status after aortic valve replacement (AVR). The aims of this study were (i) to identify significant factors influencing self-reported health status of patients assessed up to 13 years after AVR; and (ii) to compare their health with the age- and gender-matched general population.
  
  
  METHODS
  A survey questionnaire was sent to 1191 patients who had undergone AVR with or without concomitant CABG between 2000 and 2012. Physical and mental sum scores of Short Form 12 were used as dependent variables and 34 independent variables including the Minnesota living with Heart Failure Questionnaire (MLHFQ) were evaluated by hierarchical linear regression. A comparison was made with the Norwegian general population. Clinical data were obtained from the local cardiac surgery database.
  
  
  RESULTS
  In all, 912 patients (77%) responded (mean age: 73 years; 63% men). Of these, 59% had an isolated AVR. The mean assessment interval since surgery was 6 years. Several factors significantly predicted worse physical health: low education level (b: -2.8, P = 0.005), higher preoperative EuroSCORE (b: -0.88, P = 0.007), high NYHA class (b: -4.5, P < 0.001), depression (b: -5.62, P = 0.012), worse MLHFQ physical scores (b: -0.70, P < 0.001), arthritis (b: -5.13, P = 0.003), osteoporosis (b: -6.96, P = 0.010) and cancer (b: -4.48, P = 0.047) accounting for 60% of the variation (P < 0.001). Living alone (b: -3.60, P < 0.001), anxiety (b: -12.99, P < 0.001), depression (b: -6.82, P < 0.001) and worse MLHFQ emotional score (b: -0.50, P < 0.001) predicted poor mental health status, and explained 58% of the variation among AVR patients (P < 0.001). Both genders had poorer physical and mental health than their age-matched general population peers, particularly those in older age groups.
  
  
  CONCLUSIONS
  AVR patients, regardless of gender, had worse physical and mental health than the general population. Living alone, educational level, physical symptom status, anxiety and depression were the most important predictors of physical and mental health status after AVR. Implementing new screening protocols for psychosocial risk factors and individualized rehabilitation programmes may contribute to improved health in AVR patients.
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway kjersti.oterhals@helse-bergen.no.
authors.forename: Kjersti
authors.initials: K
authors.lastname: Oterhals
authors.affiliation: Division of Cardiothoracic and Respiratory Medicine, University Hospital Northern Norway, Tromsø, Norway Cardiovascular Diseases Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Tove Aminda
authors.initials: TA
authors.lastname: Hanssen
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Rune
authors.initials: R
authors.lastname: Haaverstad
authors.affiliation: Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Nordrehaug
authors.affiliation: Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Geir Egil
authors.initials: GE
authors.lastname: Eide
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Tone M
authors.initials: TM
authors.lastname: Norekvål
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000379:methods / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006349:Heart Valve Diseases / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009664:Norway; D011379:Prognosis; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Aortic valve replacement; Long-term follow-up; Self-reported health status; Short Form 12