Impact of Preoperative Functional Status on Quality of Life after Cardiac Surgery

Author(s):  
Dominik Joskowiak ◽  
Daniela Meusel ◽  
Christine Kamla ◽  
Christian Hagl ◽  
Gerd Juchem

Abstract Background With increasing importance, health-related quality of life (HRQoL) has become a crucial outcome measure of cardiac surgery. The aim of this study was to assess the dynamics of HRQoL change within 12 months after surgery and to identify predictors of deterioration in physical and mental health. Methods The cohort of this prospective study included 164 consecutive patients who underwent elective surgery. HRQoL was assessed on the basis of the Short-Form 36 questionnaire at three different times: upon admission and at 3 and 12 months after surgery. The minimal clinically important difference (MCID) was used to determine whether the surgery resulted in deterioration of HRQoL. Results In general, physical and mental health status improved within the first year after cardiac surgery. However, after 12 months, 7.9 and 21.2% of patients had clinically significant poorer physical (PCS) and mental component summary (MCS) scores, based on the MCID approach. The results of multivariate analysis identified preoperative health status, age < 70 years, coronary artery bypass grafting, and a previous neurological event as predictors of deterioration in postoperative HRQoL. The greatest risks for deterioration were higher preoperative PCS and MCS scores. Conclusion Although we were able to demonstrate a general improvement in the HRQoL following cardiac surgery, in one-fifth of patients, there was no recovery of mental health status even after 1 year. As this effect is mainly determined by preoperative functional status, HRQoL should be an integral part of medical consultation, especially in younger patients with a positive perception of quality of life.

Author(s):  
Robert Brackbill ◽  
Howard Alper ◽  
Patricia Frazier ◽  
Lisa Gargano ◽  
Melanie Jacobson ◽  
...  

Fifteen years after the disaster, the World Trade Center Health Registry (Registry) conducted The Health and Quality of Life Survey (HQoL) assessing physical and mental health status among those who reported sustaining an injury on 11 September 2001 compared with non-injured persons. Summary scores derived from the Short Form-12 served as study outcomes. United States (US) population estimates on the Physical Component Score (PCS-12) and Mental Component Score (MCS-12) were compared with scores from the HQoL and were stratified by Post-traumatic Stress Disorder (PTSD) and injury status. Linear regression models were used to estimate the association between both injury severity and PTSD and PCS-12 and MCS-12 scores. Level of injury severity and PTSD history significantly predicted poorer physical health (mean PCS-12). There was no significant difference between injury severity level and mental health (mean MCS-12). Controlling for other factors, having PTSD symptoms after 9/11 predicted a nearly 10-point difference in mean MCS-12 compared with never having PTSD. Injury severity and PTSD showed additive effects on physical and mental health status. Injury on 9/11 and a PTSD history were each associated with long-term decrements in physical health status. Injury did not predict long-term decrements in one’s mental health status. Although it is unknown whether physical wounds of the injury healed, our results suggest that traumatic injuries appear to have a lasting negative effect on perceived physical functioning.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Senoo ◽  
A Yukawa ◽  
T Okura ◽  
H Iwakoshi ◽  
T Nishimura ◽  
...  

Abstract Background and purpose Arrhythmias such as atrial fibrillation (AF) is often associated with depression, with vague anxiety about symptom and the risk of serious complication such as stroke or heart failure. In the geriatric population, geriatric depression often occurs with an increase of physical illness and has substantial costly and quality of life implications for functionality and life satisfaction. However, few studies have investigated relationship between geriatric depression and Quality of Life (QoL), and arrhythmia symptoms (palpitation, dyspnea and chest discomfort). Method Between November 2019 and October 2020, elderly people (≥65 years) who participated in the AF awareness symposium were enrolled in this study. They were divided into 4 groups according to the presence or absence of chest symptom and AF, and were examined geriatric depression by Geriatric depression scale (GDS)-15 and Quality of Life (QoL) by the 12-item Short- Form Health Survey (SF-12) including physical and mental health status. Results Of the 1511 subjects, 1364 were analyzed after excluding 147 with missing values. Among them, 911 were in the non-AF group without symptom (Group A), 43 in the AF group without symptom (group B), 323 in the non-AF group with symptom (group C), and 87 in the AF group with symptom (group D). Geriatric depression rates (defined as GDS-15 ≥10) were 2.7% in non-symptomatic group (2.7% in A [n=25] and 2.3% in B [n=1]) and 7.8% in symptomatic group (7.4% in C [n=24] and 9.2% in D [n=8]). (P&lt;0.05) In multivariate regression analysis, an increased risk of geriatric depression was observed in groups C and D (group C: odds ratio [OR]=2.54, CI: 1.40, 4.61, P&lt;0.01 and group D: OR=3.13 CI: 1.16, 7.57, P=0.02). The mean values of physical and mental health status in SF-12 were 48.5 (±7.9) and 56.7 (±6.8) in A, 44.6 (±10.7) and 57.3 (±7.3) in B, 45.0 (±9.9) and 53.8 (±7.7) in C, and 43.4 (±10.8) and 54.8 (±8.6) in D, respectively. Physical health status in SF-12 was associated with group C (C vs A: estimate −2.95 [CI: −4.03, −1.87], p&lt;0.01) and D (D vs A: estimate −2.93 [CI: −4.88, −0.97], p&lt;0.01), other than heart failure, older age and female. Mental health status in SF-12 was associated with group C (C vs A: estimated −2.34 [CI: −3.72, −1.42], p&lt;0.01), heart failure, hypertension, older age, female and group D (D vs A: estimate −1.63 [CI: −3.31, 0.05], p=0.06), but not statistically significant. Individuals with arrhythmia symptom (group C and D) had lower physical and mental health status than those without (group A and B) (P&lt;0.05). Conclusion Older adults with arrhythmia symptoms were more likely to have geriatric depression and low QoL, especially those with symptomatic AF, with a geriatric depressive complication rate of 9.2%. Further studies are needed to investigate whether improving physical health status can improve QoL and geriatric depression. FUNDunding Acknowledgement Type of funding sources: None.


2020 ◽  
Vol 103 (11) ◽  
pp. 1185-1193

Background: The systemic lupus erythematosus (SLE) patients oftentimes suffer from both physical and psychosocial challenges that may lead to low health-related quality of life (HRQoL). However, limited research has been done in this area. Objective: To examined mental health status and HRQoL among SLE patients in Thailand. Materials and Methods: The present study was a cross-sectional study conducted at the rheumatology clinic of four major hospitals in Thailand. The paper-based questionnaire consisted of demographic, health history such as depression, anxiety, stress Scale (DASS-21), and the Rosenberg self-esteem scale (RSE), and the disease-specific Lupus Quality of Life scale (LupusQoL). Depending on the variable’s level of measurement such as categorical or continuous, Spearman’s Rho or Pearson’s product moment correlation coefficients were used to explore the relationships among the variables. Hierarchical multiple regression was used to identify the predictors of LupusQoL. Results: Among the 387 participants, many might have experienced depression, anxiety, and stress (30%, 51%, and 29%, respectively). Self-esteem among the participants was good (31.8 out of 40). All eight domains of LupusQoL were affected with intimate relationship domain being impacted the most. The overall LupusQoL was significantly associated with the number of prescribed medications (r=–0.23), depression (r=–0.70), anxiety (r=–0.58), stress (r=–0.67), and self-esteem (r=0.59), p<0.001. Significant predictors of the overall LupusQoL were mental health status (depression, anxiety, and stress) and self-esteem, F (3, 81)=43.10, p<0.001, adjusted R²=0.60. Conclusion: SLE patients should be holistically assessed in both physical and psychological aspects. In addition to proper medical treatments, healthcare providers should use a multidisciplinary team approach to resolve the patients’ psychosocial issues, which in turn, may increase the patients’ quality of life. Self-care education may be necessary to help the patients manage the condition and decrease the number of medications. Keywords: Mental health, Quality of life, SLE, Thailand


2020 ◽  
Vol 18 (3) ◽  
Author(s):  
Yi MS ◽  
Wongsa L ◽  
Kittipong S

Background: Over the past few decades, Myanmar has faced mass internal migration to seek job opportunities and pursue a better life. Migration gives rise to unambiguous stress and depression. This study aimed to assess the magnitude of depression and to identify the association between socioeconomic disparity and depression among migrant workers in Myanmar. Methods and Materials: Cross-sectional study was done among 1,201 migrants in Yangon Region. To assess the socioeconomic status, mental health status, accessibility of health care service and Quality of Life by developing self–administered questionnaire. The Generalized Linear Mixed Model was applied to determine the association between socioeconomic disparity and depression after adjusting for other covariates. Result: Their average age was 31.44 ±10.31 years. Gender distribution was not much different. About one third of respondents were factory workers and had low level of education. The magnitude of depression was 38.22% (95%CI= 35.50-41.00). Regarding the socioeconomic disparity, adequacy of income (AOR= 1.79, 95%CI: 1.35-2.37, p value<0.001) and floor surface area of the houses (AOR= 1.21, 95%CI: 1.00-1.47, p value><0.001) were strongly associated with depression. Moreover, other factors that were associated with depression were stress, quality of life and burden of medical service cost. Conclusion: Two-fifth of internal migrant workers suffered depression. The findings highlighted to develop intervention aimed to improve mental health status among migrants. In order to achieve the sustainable development goals, it is important to make investment on mental health of the migrant workers.> <0.001) were strongly associated with depression. Moreover, other factors that were associated with depression were stress, quality of life and burden of medical service cost. Conclusion: Two-fifth of internal migrant workers suffered depression. The findings highlighted to develop intervention aimed to improve mental health status among migrants. In order to achieve the sustainable development goals, it is important to make investment on mental health of the migrant workers.


2020 ◽  
Vol 32 (9) ◽  
pp. 585-590
Author(s):  
Generosa Do Nascimento ◽  
Francisco Guilherme Nunes ◽  
Janet E Anderson

Abstract Objective To determine to what extent patient health status and recovery in post-acute care organizations (PACO) is related to patient experience of the discharge process from hospital and to patient experience while staying in these facilities. Design Longitudinal study of patients discharged from hospitals to PACO. Setting 12 hospitals and 14 PACO Portuguese organizations. Participants 181 patients participated in the both stages of data gathering. Main Outcome Measures Patients’ physical and mental health status was measured through the 36-item short form health survey scale. The experience of transition from hospital to PACO was measured with the Care Transition Measure. The Picker Adult In-Patient Questionnaire was used to measure patients’ experience in these organizations. Results Patients reporting better physical condition in PACO had a better experience on discharge [b = 0.21, 95% confidence interval, CI (0.10, 0.31)] and perceive fewer problems inside facilities [b = − 0.19, 95% CI (−0.31, 0.08)]. The experience in PACO is significantly related to patients’ mental health status [b = − 0.47, 95% CI (−0.59, − 0.36)]. Patients showing higher levels of physical recovery had a better experience on discharge [b = − 0.18, 95% CI (0.08, 0.28)], while those registering better mental recovery experienced fewer problems during their stay [b = − 0.41, 95% CI (−0.52, − 0.30)]. Conclusions PACO play a key role in maintaining and promoting patients’ health, and this goal is influenced by their experience both in the transition from hospitals to PACO and while staying in these facilities.


Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 647
Author(s):  
Natasa Todorovic ◽  
Milutin Vracevic ◽  
Nina Rajovic ◽  
Vedrana Pavlovic ◽  
Petar Madzarevic ◽  
...  

Background and objectives: The COVID-19 pandemic has had an unprecedented reliance on informal caregivers as one of the pillars of healthcare systems. The aim of this study was to assess the quality of life of informal caregivers during the COVID-19 epidemic in Serbia. Materials and Methods: A cross-sectional study was conducted among informal caregivers during the COVID-19 epidemic in Serbia. Physical and mental quality of life was measured by the 36-Item Short-Form Health Survey. Additional data included sociodemographic characteristics, caregiver and care recipient characteristics, and COVID-19 related concerns. The qualitative component was performed using focus groups and individual in-depth interviews. Results: Out of 112 informal caregivers enrolled, most were female (80%), and the average age was 51.1 ± 12.3 years. The majority was delivering care to one person, who was a family member, on a daily basis (86.4%, 92%, and 91.1%, respectively). In multiple regression models, significant predictors of caregivers’ physical health were delivering care to a family member and a higher level of care complexity, while significant predictors of caregivers’ mental health were a higher level of care complexity and increased concerns about self-health and the health of the person being cared for due to the COVID-19 epidemic. Conclusions: Informal caregivers are experiencing negative physical and mental health outcomes during the COVID-19 epidemic in Serbia.


Medicine ◽  
2016 ◽  
Vol 95 (19) ◽  
pp. e3523 ◽  
Author(s):  
Kyoung In Jung ◽  
Chan Kee Park

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