Department of Cardiothoracic Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Cardiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; National Competence Centre for Complex Symptom Disorders, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiothoracic Anaesthesiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
J Thorac Cardiovasc Surg. 2018 Dec;156(6):2183-2190.e2. doi: 10.1016/j.jtcvs.2018.05.087. Epub 2018 Jun 7.
Health-related quality of life (HRQOL) is an important end point after cardiac surgery, particularly in patients of older age. However, prospective long-term studies describing the trajectory of HRQOL after cardiac surgery are still scarce. Therefore, the aim was to assess survival, functional status, and trajectory of HRQOL 10 years after cardiac surgery.
In a prospective population-based study, 534 patients (23% aged 75 years or older, 67% male) were consecutively included before surgery. Functional status was measured according to self-assigned New York Heart Association (NYHA) classification. HRQOL was measured using the Short-Form Health Survey (SF-36). Questionnaires were given to the patients at baseline and sent by post at 6 and 12 months, and 5 and 10 years after surgery.
Three hundred fifty-two patients were eligible after 10 years, 274 responded (77.8%). Total survival at 10 years was 67.8%. Patients aged 75 years or older at surgery had lower survival rates than younger patients (44.6% vs 74.6%, P < .001). Seven of 8 SF-36 subscales were improved at 10 years compared with baseline. Older patients improved less than younger patients and linear mixed models showed that older patients had significantly worse trajectories on 3 of 8 SF-36 subscales. NYHA classification improved from baseline to 10 years also among older patients, with 59% in NYHA class III/IV at baseline compared with 30.3% after 10 years (P < .013).
HRQOL and function improved from before to 10 years after cardiac surgery, also for older patients. These long-term results are of major importance when discussing the use of health care resources and patient-centered clinical decision-making.
健康相关生活质量（HRQOL）是心脏手术后的一个重要终点，特别是对于老年患者而言。然而，描述心脏手术后 HRQOL 轨迹的前瞻性长期研究仍然很少。因此，本研究旨在评估心脏手术后 10 年的生存率、功能状态和 HRQOL 轨迹。
在一项前瞻性的基于人群的研究中，连续纳入了 534 名患者（23%年龄在 75 岁或以上，67%为男性）。功能状态根据自我分配的纽约心脏协会（NYHA）分级来测量。HRQOL 使用健康调查简表（SF-36）进行测量。在基线时向患者发放问卷，并在术后 6 个月、12 个月、5 年和 10 年通过邮寄方式发送问卷。
10 年后有 352 名患者符合条件，其中 274 名患者（77.8%）做出回应。10 年总生存率为 67.8%。手术时年龄在 75 岁或以上的患者生存率低于较年轻的患者（44.6%比 74.6%，P<.001）。与基线相比，SF-36 8 个分量表中有 7 个在 10 年后得到改善。较年长患者的改善程度低于较年轻患者，线性混合模型显示，在 SF-36 的 8 个分量表中，较年长患者有 3 个分量表的轨迹明显较差。NYHA 分级也从基线改善到 10 年，在基线时为 NYHA Ⅲ/Ⅳ级的患者中有 59%在 10 年后降至 30.3%（P<.013）。
心脏手术后 10 年，HRQOL 和功能均得到改善，老年患者也是如此。这些长期结果对于讨论医疗保健资源的使用和以患者为中心的临床决策具有重要意义。
