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Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Feb 3;24(5):385–392. doi: 10.1002/clc.4960240508

Relief of symptoms and improvement of health‐related quality of life five years after coronary artery bypass graft in women and men

Johan Herlitz 1,, Ingela Wiklund 2, Helén Sjöland 1, Björn W Karlson 1, Thomas Karlsson 1, Maria Haglid 1, Marianne Hartford 1, Kenneth Caidahl 1
PMCID: PMC6655063  PMID: 11347626

Abstract

Background: Severe coronary artery disease can be successfully treated with coronary artery bypass graft (CABG), with considerable improvement in the symptoms of angina pectoris. Approximately three of four patients are free of ischemic events for 5 years; however, increased survival is demonstrated only in selected subgroups with advanced coronary artery disease, and this effect has not been established in elderly patients.

Hypothesis: The study was undertaken to determine the relief of symptoms and improvement in other aspects of health‐related quality of life (QoL) during 5 years after CABG in women and men.

Methods: Patients who underwent CABG in western Sweden were approached prior to and 5 years after surgery. Health‐related QoL was estimated with Physical Activity Score (PAS), Nottingham Health Profile, and Psychological General Well‐Being Index.

Results: Women (n = 381) had a 5‐year mortality of 17% compared with 13% for men (n = 1,619; NS). After 5 years, 1,719 patients (survivors) were available for the survey; of these, 876 (51%) answered the inquiry both prior to and after 5 years. Both women and men improved markedly and highly significantly, both with respect to symptoms and other aspects of health‐related QoL. Women suffered more than men in terms of limitation of physical activity, dyspnea, chest pain, and others aspects of health‐related QoL. There was a significant interaction between time and gender, with more improvement in men with regard to chest pain when walking uphill or quickly on level ground, when walking on level ground at the speed of other persons their own age, when under stress, and in windy and cold weather. For those parameters as well as for PAS, improvement was more marked in men than in women. In the other aspects of health‐related QoL, there was no interaction between time and gender.

Conclusion: Five years after CABG, limitation of physical activity, symptoms of dyspnea, and chest pain were reduced, and various aspects of health‐related QoL had improved in both women and men. In general, women suffered more than men both prior to and after CABG; however, in some aspects the improvement was more pronounced in men. Because of the limited response rate, the results may not be applicable to a nonselected population who had undergone CABG.

Keywords: coronary artery bypass graft, gender, quality of life

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References

  • 1. European Coronary Surgery Study Group : Long‐term results of prospective randomised study of coronary artery bypass surgery in stable angina pectoris. Lancet 1982; ii: 1173–1180 [PubMed] [Google Scholar]
  • 2. CASS Principal Investigators and their associates : Coronary artery surgery study (CASS): A randomized trial of coronary artery bypass surgery. Circulation 1983; 68: 951–960 [DOI] [PubMed] [Google Scholar]
  • 3. Hultgren HN, Peduzzi P, Detre K, Takaro T, and the study participants : The 5‐year effect of bypass surgery on relief of angina and exercise performance. Circulation 1985; 72 (suppl V): V‐79‐V‐83 [PubMed] [Google Scholar]
  • 4. Kirklin JW, Naftel DC, Blackstone EH, Pohost GM: Summary of a consensus concerning death and ischemic events after coronary artery bypass grafting. Circulation 1989; 79 (suppl I): I‐81‐I‐91 [PubMed] [Google Scholar]
  • 5. Varnauskas E, and the European Coronary Surgery Study Group : Twelve‐year follow‐up of survival in the randomized European Coronary Surgery Study. N Engl J Med 1988; 319: 332–337 [DOI] [PubMed] [Google Scholar]
  • 6. Califf RM, Harrell FE Jr, Lee KL, Scott Rankin J, Hlatky MA, Mark DB, Jones RH, Muhlbaier LH, Newlander Oldham H, Pryor DB: The evolution of medical and surgical therapy for coronary artery disease: A 15‐year perspective. J Am Med Assoc 1989; 261: 2077–2086 [PubMed] [Google Scholar]
  • 7. Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Kilip T, Passamani E, Norris R, Morris C, Mathur V, Varnauskas E, Chalmers TC: Effect of coronary artery bypass graft surgery on survival: Overview of 10‐year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994; 344: 563–570 [DOI] [PubMed] [Google Scholar]
  • 8. Sjöland H, Caidahl K, Karlson BW, Karlsson T, Herlitz J: Limitation of physical activity, dyspnea and chest pain before and two years after coronary artery bypass grafting in relation to sex. Int J Cardiol 1997; 61: 2: 123–133 [DOI] [PubMed] [Google Scholar]
  • 9. Sjöland H, Wiklund I, Caidahl K, Hartford M, Karlsson T, Herlitz J: Improvement in quality of life differs between women and men after coronary artery bypass surgery. J Intern Med 1999; 245: 445–454 [DOI] [PubMed] [Google Scholar]
  • 10. Rose GA, Blackburn H, Gillum RF, Prineas RJ: Cardiovascular survey methods. World Health Organization Monograph Series No. 56, Geneva, 2nd ed., 1982; 162–166 [PubMed]
  • 11. Eriksson H, Caidahl K, Svärdsudd K, Larsson B, Ohlson L‐O, Welin L, Wilhelmsen L: Cardiac and pulmonary causes of dyspnoea‐validation of a scoring test for clinical‐epidemiological use: The study of men born in 1913. Eur Heart J 1987; 8: 1007–1014 [DOI] [PubMed] [Google Scholar]
  • 12. Caidahl K, Svärdsudd K, Eriksson H, Wilhelmsen L: Relation of dyspnea to left ventricular wall motion disturbances in a population of 67‐year‐old men. Am J Cardiol 1987; 59: 1277–1282 [DOI] [PubMed] [Google Scholar]
  • 13. Hagman M, Wilhelmsen L, Pennert K, Wedel H: Factors of importance for prognosis in men with angina pectoris derived from a random population sample. The Multifactor Primary Prevention Trial. Gothenburg, Sweden. Am J Cardiol 1988; 61: 530–535 [DOI] [PubMed] [Google Scholar]
  • 14. Wilson A, Wiklund I, Lahti T, Wahl M: A summary index for the assessment of quality of life in angina pectoris. J Clin Epidemiol 1991; 44: 981–988 [DOI] [PubMed] [Google Scholar]
  • 15. Wiklund I, Romanus B, Hunt S: Self‐assessed disability in patients with arthrosis of the hip joint. Reliability of the Swedish version of the Nottingham Health Profile. Int Disabil Study 1988; 10: 159–163 [DOI] [PubMed] [Google Scholar]
  • 16. Hunt S, Wiklund I: Cross‐cultural variation in the weighting of health statements: A comparison of English and Swedish valuations. Health Policy 1987; 8: 227–235 [Google Scholar]
  • 17. Dupuy H: The Psychological General Well‐Being (PGWB) Index In Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapies (Eds. Wenger NK, Mattson ME, Furberg CD, Elinson J.), p. 170–183. New York: Le Jacq Publishers, Inc., 1984. [DOI] [PubMed] [Google Scholar]
  • 18. Hunt SM, McKenna SP, Williams J: Reliability of a population survey tool for measuring perceived health problems: A study of patients with osteoarthrosis. J Epidemiol Commun Health 1981; 35: 297–300 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Hunt SM, McEwen J, McKenna SP: Perceived health: Age and sex comparisons in a community. J Epidemiol Commun Health 1984; 38: 156–160 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20. Dimenäs E, Carlsson G, Glise H, Israelsson B, Wiklund I: Relevance of norm values as part of the documentation of quality of life instruments for use in upper gastrointestinal disease. Scand J Gastroenterol 1996; 31 (suppl 221): 8‐13 [DOI] [PubMed] [Google Scholar]
  • 21. Mayou R: The patient with angina: Symptoms and disability. Postgrad Med J 1973; 49: 250–254 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22. Dongier M: Psychosomatic aspects in myocardial infarction in comparison with angina pectoris. Psychother Psychosom 1974; 23: 123–131 [DOI] [PubMed] [Google Scholar]
  • 23. Smith TW, Follicle MJ, Korr KS: Anger, neuroticism, Type A behaviour and the experience of angina. Br J Med Psychol 1984; 57: 249–252 [DOI] [PubMed] [Google Scholar]
  • 24. Hunt S: Subjective health indicators and health promotion. Health Prom 1986; 3: 1–12 [Google Scholar]
  • 25. Caine N, Harrison SCW, Sharples LD, Wallwork J: Prospective study of quality of life before and after coronary artery bypass grafting. Br Med J 1991; 302: 511–516 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Pocock SJ, Henderson RA, Seed P, Treasure T, Hampton JR: Quality of life, employment status, and anginal symptoms after angioplasty of bypass surgery: Three‐year follow‐up in the Randomized Intervention Treatment of Angina (RITA) Trial. Circulation 1996; 94: 135–142 [DOI] [PubMed] [Google Scholar]
  • 27. Goldman L, Hashimoto B, Cook F, Loscalzo A: Comparative reproducibility and validity of systems for assessing cardiovascular functional class: Advantages of a new specific activity scale. Circulation 1981; 64: 1227–1234 [DOI] [PubMed] [Google Scholar]
  • 28. Walter PJ: Return to work after coronary artery bypass surgery. Eur Heart J 1988; 9 (suppl L): 58–66 [DOI] [PubMed] [Google Scholar]
  • 29. Wiklund I: Quality of life in arthritis patients using nonsteroidal anti‐inflammatory drugs. Can J Gastroenterol 1999; 13: 129–133 [DOI] [PubMed] [Google Scholar]
  • 30. Wiklund I, Herlitz J, Johansson S, Bengtson A, Karlson BW, Persson NG: Subjective symptoms and well‐being differ in women and men after myocardial infarction. Eur Heart J 1993; 14: 1315–1319 [DOI] [PubMed] [Google Scholar]
  • 31. Czajkowski SM, Terrin M, Lindquist R, Hoogwerf B, Dupuis G, Schumaker SA, Gray R, Herd JA, Treat‐Jacobson D, Zyzanski S, Knatterud GL, for the POST CABG Biobehavioral Study Investigators : Comparison of preoperative characteristics of men and women undergoing coronary artery bypass grafting (the Post Coronary Artery Bypass Graft [CABG] Biobehavioral Study). Am J Cardiol 1997: 79 (8): 1017–1024 [DOI] [PubMed] [Google Scholar]
  • 32. Sjöland H, Hartford M, Caidahl K, Karlson BW, Wiklund I, Karlsson T, Herlitz J: Improvement in various estimates of quality of life after coronary artery bypass grafting in patients with and without a history of hypertension. J Hypertens 1997: 15 (9): 1033–1039 [DOI] [PubMed] [Google Scholar]
  • 33. Hunt SM, McEwen J, McKenna SP: Perceived health: Age and sex norms in a community. J Epidemiol Comm Health 1984; 38: 150–160 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34. Sjöland H, Herlitz J, Karlson BW, Karlsson T, Caidahl K: Influence of patient sex and clinical history on working capacity and myocardial ischemia after coronary artery bypass surgery. Cor Art Dis 1995; 6: 561–571 [PubMed] [Google Scholar]
  • 35. Sjöland H, Caidahl K, Wiklund I, Haglid M, Hartford M, Karlson BW, Karlsson T, Herlitz J: Impact of coronary artery bypass grafting on various aspects of quality of life. Eur J Cardiothorac Surg 1997; 12: 612–619 [DOI] [PubMed] [Google Scholar]
  • 36. Klersy C, Collarini L, Morellini MC, Cellino F: Heart surgery and quality of life: A prospective study on ischemic patients. Eur J Cardiothorac Surg 1997; 12: 602–609 [DOI] [PubMed] [Google Scholar]
  • 37. Brezinka V, Kittel F: Psychosocial factors of coronary heart disease in women: A review. Soc Sci Med 1996; 42: 1351–1365 [DOI] [PubMed] [Google Scholar]
  • 38. Becker RC, Corrao JM, Alpert JS: Coronary artery bypass surgery in women. Clin Cardiol 1988; 11 (7): 443–448 [DOI] [PubMed] [Google Scholar]
  • 39. O'Connor NJ, Morton JR, Birkmeyer JD, Olmstead EM, O'Connor GT: Effect of coronary artery diameter in patients undergoing coronary bypass surgery. Northern New England Cardiovascular Disease Study Group. Circulation 1996; 93: 652–655 [DOI] [PubMed] [Google Scholar]
  • 40. Mautner SL, Lin F, Mautner GC, Roberts WC: Comparison in women versus men of composition of atherosclerotic plaques in native coronary arteries and in saphenous veins used as aortocoronary conduits. J Am Coll Cardiol 1993; 21: 1312–1318 [DOI] [PubMed] [Google Scholar]
  • 41. Hwang MH, Meadows WR, Palac RT, Piao ZE, Pifarre R, Loeb HS, Gunnar RM: Progression of native coronary artery disease at 10 years: Insights from a randomized study of medical versus surgical therapy for angina. J Am Coll Cardiol 1990; 16: 1066–1070 [DOI] [PubMed] [Google Scholar]
  • 42. Vigorito C, Betocchi S, Giudice P, Miceli D: Severity in coronary artery disease in patients with diabetes mellitus: Angiographic study of 34 diabetic and 120 non‐diabetic patients. Am Heart J 1980; 100: 782–787 [DOI] [PubMed] [Google Scholar]
  • 43. Eriksson SV, Björkander I, Held C, Hjemdahl P, Forslund L, Rehnqvist N: Age and gender differences in left ventricular function among patients with stable angina and a matched control group. A report from the Angina Prognosis Study in Stockholm. Cardiology 1996: 87 (4): 287–293 [DOI] [PubMed] [Google Scholar]
  • 44. Lindenfeld J, Krause‐Steinrauf H, Salerno J: Where are all the women with heart failure?. J Am Coll Cardiol 1997: 30: 1417–1419 [DOI] [PubMed] [Google Scholar]
  • 45. Mendes LA, Davidoff R, Cupples A, Ryan TJ, Jacobs AK: Congestive heart failure in patients with coronary artery disease: The gender paradox. Am Heart J 1997; 134: 207–212 [DOI] [PubMed] [Google Scholar]
  • 46. Landahl S, Steen B, Svanborg A: Dyspnea in 70‐year‐old people. Acta Med Stand 1980; 207: 225–230 [DOI] [PubMed] [Google Scholar]

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