Quality of life after Open Heart surgery in Adults: A prospective study in 400 patients followed up at Queen Alia Heart

1. Quality of life after Open Heart surgery in Adults: A prospective study in 400 patients followed up at Queen Alia Heart Institute Amman/Jordan

2. Dr. Yanal Al-Naser, MD,AFRCSI,MRCSI • Amani M. Al-Elawi, RN. • Rana A. Al-Rwashdeh,RN (the presenter). • Huda I. Abu-Yabes, RN. • Yanal Al-Hnaite, RN. • Atalla Al-Olimat, perfusionist.

3. Open heart surgery continues to be the mainstay of treatment for early and advanced heart diseases and deformities that cannot be tackled percutaneously.

4. Quality of life (QOL) following open heart surgery (OHS) has not been systematically studied. • The purpose of the study was to define the benefit of cardiac surgery to the individual,the family, and the community, and to evaluate the intermediate to long-term QOL in patients with heart disease following open heart surgery.

5. A prospective QoL registration started in 2007 for all patients undergoing open heart surgery for various cardiac diseases. Between January 2007 and Jan 2008,400 patients all aged above 20 were randomly included .

6. Questionnaires were administered pre-operatively and 1, 3, 6 and 12 months post-operatively with response rates of 100%, 71%, 77%, 83% and 76%, respectively.

7. The patients were interviewed at set intervals, using a pre- set, standardized questionnaire. The first interview was pre op. after referral from the cardiologist for surgery. It took place in the ward on admission to hospital for surgery. The remaining interviews-at one month postoperatively, three months, six months, and twelve months thereafter-took place in the follow up clinic and were timed to coincide with outpatient appointments.

8. 12 patients died before completing the follow up, and 5 patients were followed up elsewhere. The remaining 383 patients (201 men, 182 women) were aged from 21 to 62.

9. The QOL was assessed using a standardized questionnaire, The questionnaire included questions on occupation, dyspnoea, activity limitations, physical dependence, leisure time activities, sexual life, and changes of mood. Three patients were unable to understand the questionnaires due to being old and illiterate, for which the questionnaire was read out loud and clarified.

10. PROCEDURES: • Out of the 400 patients, 129 patients had valve replacements (some combined with other procedures), 212 coronary artery bypass grafts, and 23 repair of septal defects, and 19 had miscellaneous operations.

11. RESULTS: • After two months less than 10% of the men were so handicapped that they could not leave their houses unaccompanied.

12. This figure compares with 34% for women, who on average took longer to recover. Women were more physically dependent than men on their families, both preoperatively and in the early postoperative months. • The difference became less with time,

13. 56 people who still had some limitations at 6 months, 23 said that the limiting factor was dyspnoea, nine that it was fatigue, eight had chest pain, and two were afraid of exertion. • The remainder gave various reasons unconnected with their heart condition.

14. Of the 291 people followed up for the longest period (12 months): • 171 said that their mood had improved since operation, 113 that their sex life was better, and 238 described a greater sense of well being.

15. It has been suggested4 that, "Work is a habit which, if allowed to lapse, is replaced by the habit of non-work." • Of 128 men of employment age (under 55 during the period of the study) who survived for at least 8 months postoperatively, half were back to work within 15 months of surgery

16. In this study, we found that patients undergoing open heart surgery enjoyed good QOL and high levels of functioning after a follow-up time of 1 year. OHS patients tended to score high on QOL and functioning scales and reported relatively few symptoms. Particular attention has been paid in this study to the incidence of long-term pain. This was assessed with our standardized and self developed mid sternotomy pain scale, which combined the scores of questions on pain and numbness in and around the scar, along with effects of climatic changes. . A large percentage of patients still reported some degree of pain ( 74%) after 4 months of follow up, for which infrequent pain killers were used, this percentage dropped to (47%) after 6 moths, and less than (12%) after 12 months of follow up

17. The return to work was again another aspect of great focus here. The return to work pattern for men of employment age showed that half were back to work in just over three months and 80%' by the end of a year after operation. The longer the individual had been off work preoperatively, the longer it took to return to work. Between 50%" and 85%/' returned to their old job, depending on how long they had been off work before operation. Although the numbers were smaller, the favorable trend for full-time and part-time employment was also seen for the women in the series.

18. Changes in life aspects of men showing the percentage in relation to weeks after surgery.

19. Changes in life aspects of women showing the percentage in relation to weeks after surgery

20. To our knowledge, this study represents a good step in documenting short and intermediate to long-term QOL in patients following open heart surgery using standardized and validated questionnaires. Despite some limitations and the lack of statistically significant findings, our findings offer valuable information regarding post operative quality of life

21. CONCLUSION • The results, for a total of 400 patients followed up for a maximum of 12 months after surgery, showed that open heart surgery is well tolerated by the majority of patients and that there is an overall improvement in all aspects of life social, academic, leisure and sexual for most patients.