Psychosocial outcomes of coronary bypass surgery

Investigators:
Ms Rosemary Higgins, Dr Marian Worcester, Dr Barbara Murphy, Dr Alan Goble, Dr Peter Elliott, Mr Michael Le Grande, Ms Anne Parkinson, Heart Research Centre.

As part of the larger trial comparing neuropsychological outcomes of coronary bypass surgery with and without the use of the heart bypass machine, an additional study was conducted to investigate psychosocial outcomes of patients. Self report questionnaires were administered before surgery and after two and six months to assess emotional functioning, social functioning and quality of life of both patient and partner.

Many studies have been undertaken in the past to investigate psychological responses to coronary bypass surgery. Results of these studies show that mood disturbances are common. Anxiety, depression, agitation, anger, symptoms of stress, personality disturbance, social difficulties and mood changes have all been reported. While some trials have been conducted to compare the impact upon cognitive function of "on pump" and "off pump" surgery, no studies have systematically examined psychological outcomes of patients entered into these trials. Questionnaires were administered to patients on the waiting list for coronary bypass surgery at The Royal Melbourne Hospital and again after eight weeks and six months.

A second study examined the psychosocial functioning of patients after CABGS. Over half experienced an improvement in quality of life during the first six months. There was a steady improvement in physical symptoms and resumption of activities. However, recovery of emotional well-being was slower than physical recovery.  Key predictors of a poorer quality of life included previous cardiac surgery and the presence of more severe symptoms before surgery, particularly breathlessness. Patients out of the workforce or in manual occupations also showed persistently low quality of life after their operation. Depressed patients were also more likely to show persistent limitations in quality of life, particularly in recovery of their social and emotional well-being. Having a partner facilitated recovery of emotional quality of life in patients.  Findings of the study highlight the need to identify those patients at risk of poorer quality of life and to develop interventions to support them.  

While many studies have investigated cognitive impairment in patients after CABGS, few have evaluated their pre-surgical cognitive functioning. We compared the neuropsychological functioning of 109 patients in the above study with that of a healthy control group and published normative data. Cognitive test scores of candidates for surgery were lower than the other two groups.  Possible explanations for pre-bypass cognitive difficulties include emotional distress prior to surgery, the cardiac disease process itself and unrecognised cerebrovascular disease which may accompany cardiovascular disease.

Funding: Percy Baxter Charitable Trust