Bradshaw Pamela J, Jamrozik Konrad D, Gilfillan Ian S, Thompson Peter L
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Am Heart J. 2006 Feb;151(2):537-44. doi: 10.1016/j.ahj.2005.04.007.
Health-related quality of life (HRQOL) among long-term survivors of coronary artery bypass surgery is an important outcome that has been little studied at the population level.
A postal survey was conducted in 1999 to 2000 in patients 6 to 20 years after coronary artery bypass graft (CABG) surgery in Western Australia. A random stratified sample of 2500 was drawn from 8910 patients who had their first CABG surgery in 1980 to 1993. Health-related quality of life was measured with Short Form 36 and EuroQol visual analogue scale.
Response was 82% (n = 2061). Health-related quality of life declined with age and was similar for men and women, although scores for women were worse for physical functioning. Compared with Australian population norms, the age- and sex-standardized scores of survivors of CABG were generally worse, mainly in the physical domain. Reported angina at the time of follow-up (33%), symptoms of heart failure equivalent to New York Heart Association (NYHA) classes II to IV (34%), and comorbidities such as diabetes and hypertension were associated with poorer HRQOL. For both men and women without angina or heart failure at follow-up, HRQOL was no different from that of the general population.
Overall, the quality of life among long-term survivors of CABG is worse than that of the general population, the difference being mainly attributable to recurrent symptoms and comorbidities. Quality of life for those without angina or heart failure at follow-up was equivalent to the population norms, providing an incentive to maximize efforts to abolish angina and ameliorate heart failure symptoms.
冠状动脉搭桥手术长期存活者的健康相关生活质量(HRQOL)是一项重要结局,但在人群层面上研究较少。
1999年至2000年对西澳大利亚州冠状动脉搭桥术(CABG)后6至20年的患者进行了邮寄调查。从1980年至1993年首次接受CABG手术的8910名患者中随机抽取2500名进行分层抽样。使用简短健康调查问卷36项版本(Short Form 36)和欧洲五维度健康量表视觉模拟评分法(EuroQol visual analogue scale)测量健康相关生活质量。
应答率为82%(n = 2061)。健康相关生活质量随年龄下降,男性和女性相似,尽管女性在身体功能方面的得分更差。与澳大利亚人群标准相比,CABG存活者的年龄和性别标准化得分总体较差,主要在身体领域。随访时报告有胸痛(33%)、相当于纽约心脏协会(NYHA)II至IV级的心力衰竭症状(34%)以及糖尿病和高血压等合并症与较差的HRQOL相关。对于随访时无胸痛或心力衰竭的男性和女性,HRQOL与普通人群无异。
总体而言,CABG长期存活者的生活质量比普通人群差,差异主要归因于复发症状和合并症。随访时无胸痛或心力衰竭者的生活质量与人群标准相当,这为最大限度地努力消除胸痛和改善心力衰竭症状提供了动力。