Quality of life and functional capacity in patients after cardiac surgery intensive care unit

Table 1 Characteristics of studies that evaluated patient outcomes after coronary artery bypass grafting and other cardiac surgery

Ref.	Study design	Purpose	Population (n)	Male/female; age in yr	Cardiopulmonary bypass time in min/X-clamp time in min	Intervention	Outcomes	Main results
Deschka et al[11], 2013	Observational study	To assess survival, functional capacity, and QoL 1 year after cardiac surgery	CABG, HVS, combined procedures, aortic surgery, miscellaneous, emergency procedures (119)	84/35; 72.2 ± 9.3	NA	Barthel mobility index, SF-12 questionnaire	Long-term ICU treatment after cardiac surgery is related to a high in-hospital and follow-up mortality	In-hospital: Mortality was 36.1%, 1-year overall survival was 46.2%, and 1-year survival of the discharged patients was 72.4%. Preoperative Barthel mobility index was 94.7% ± 13.9% vs 85.2% ± 23.0% postoperatively. QoL was comparable with the normative population
Peric et al[49], 2015	Observational study	To evaluate the changes in QoL 6 months after CABG surgery related to the patients’ age	CABG (226)	181/45; 58.3 ± 8.3/61.6 ± 6.1	On pump procedure	NHP questionnaire part 1 before and 6 months after surgery	Improvement of QoL after 6 months in older patients. Age is not an independent predictor of QoL deterioration after CABG	Before CABG elderly patients had worse QoL in sections of PM (r = 0.22, P = 0.001), SI (r = 0.16, P = 0.009) and En (r = 0.23, P = 0.001). After 6 months, patients group < 50 years improved in sections of PM, En, pain, and sleep. Group 60-69 years improved in all sections. Group 50-59 years and ≥ 70 years also improved in all sections except SI and sleep respectively. There was a significant relationship between patient’s age and improvement of QoL in sections of PM (r = 0.18, P = 0.008), SI (r = 0.17, P = 0.01) and En (r = 0.21, P = 0.002)
Westerdahl et al[51], 2016	Prospective study	To investigate pulmonary function and HRQoL 1 year after cardiac surgery	CABG, HVS, or combined surgery (150)	123/27; 66 ± 9	112 ± 53/84 ± 46	SF-36 questionnaire, pulmonary function measurements	HRQoL improved in comparison to preoperative values. Static and dynamic lung function measurements slightly decreased, levels of pain were low, and saturation of peripheral oxygen was same as preoperatively	HRQoL improved in all 8 aspects of SF-36 (P < 0.001). FVC decreased by 4%-5% compared to preoperative values (P < 0.05). Sternotomy-related pain at rest was 0 (0-7), at deep breath 0 (0-4) and at coughing 0 (0-8)
Gjeilo et al[12], 2018	Prospective, observational cohort study	To assess survival, functional status, and HRQoL 10 years after cardiac surgery	Isolated CABG, HVS, CABG with HVS, miscellaneous (274)	228/46; 64.1 ± 9.9	64.0 (range: 16.0-206)/40.0 (5.0-180.0)	SF-36 questionnaire NYHA classification	HRQoL and function improved from before to 10 years after cardiac surgery, also for older patients	Total survival at 10 years was 67.8%. HRQoL improved compared with baseline in 7 of 8 SF-36 subscales. Older patients improved less than younger patients (3 of 8 SF-36 subscales were worse). NYHA classification improved also among older patients (from 59% in NYHA class III/IV at baseline to 30.3% after 10 years, P < 0.013)
Joskowiak et al[39], 2022	Prospective cohort study	To assess HRQoL change within 12 months after cardiac surgery and to identify predictors of deterioration in physical and mental health	CABG, AVR, CABG and AVR, aortic surgery, other surgery, redo surgery (164)	123/41; 70 (range: 62-76)	122.9 ± 37.4/81.8 ± 27.6	SF-36 questionnaire upon admission and at 3 months and 12 months after surgery	Gradual improvement of physical and mental health status	PCS score increased from 40.1 (range: 31.9-49.9) before surgery to 46.3 (37.0-52.4) at 3 months and 52.4 (46.4-56.3) at 12 months after surgery. The MCS score increased from 48.8 (38.6-55.3) at baseline to 50.9 (38.9-57.2) at 3 months and 53.1 (42.0-57.8) at 12 months after surgery. Up to 7.9% and 21.2% of patients had poorer PCS and MCS scores respectively at 12 months. Predictors of deterioration in postoperative HRQoL are preoperative health status, age < 70 years, CABG and a previous neurological event
Muthukrishnan et al[50], 2023	Prospective cohort study	To determine the QoL 3 months after CABG surgery	CABG (200)	184/16; 55 (12.5)		SF-36 questionnaire and STAI scale 2 days before and 3 months after CABG surgery	Improvement in physical health. Preoperative anxiety was a significant predictor of physical health	PCS score was 34.57 ± 9.6 preoperative vs 43.53 ± 7 postoperative. MCS score respectively was 54.87 ± 1.19 vs 51.65 ± 9.67. Perception of low physical health QoL was due to preoperative anxiety (β = 0.535, t = 8.433, P < 0.001)

AVR: Aortic valve surgery; CABG: Coronary artery by-pass grafting; CAD: Coronary artery disease; En: Energy; FVC: Forced vital capacity; HRQoL: Health-related quality of life; HVS: Heart valve surgery; MCS: Mental component summary; NA: Not available; NYHA: New York Heart Association; PCS: Physical component summary; PM: Physical mobility; QoL: Quality of life; SI: Social isolation; STAI: State-trait anxiety inventory; SF-36: Short-Form Health Survey-36.

Table 2 Characteristics of the studies reviewed for patients after heart valve surgery

Ref.	Study design	Purpose	Population (n)	Male/female (n); age in yr	X-clamp time in min	Intervention	Outcomes	Main results
Thomson Mangnall et al[48], 2014	Prospective study	To evaluate the HRQoL after heart valve replacement surgery	Rheumatic heart disease (128)	56/72; 26.7 (12.4)	NA	SF-36 questionnaire (preoperatively and 1, 2, and > 2 years postoperatively)	Significant improvement of HRQoL sustained over time	Preoperative HRQoL was impaired but at 1 year postoperative improved across all domains (P < 0.05) apart from mental health (P = 0.081). At 2 years it remained improved from preoperative measurement, with mental health now significantly better (P = 0.028). By > 2 years follow-up all HRQoL domains, except for mental health, were significantly better than preoperative (P = 0.066)
Jansen Klomp et al[24], 2016	Prospective, observational cohort study	To investigate the influence of age on postoperative outcomes and HRQoL 1 year after SAVR	AS age < 80 (597) and AS age ≥ 80 (163)	363/234 and 85/78; 71 (range: 66-75) and 82 (81-83)	91 (range: 75-111) and 82 (68-107)	SF-36 questionnaire (PCS and MCS score)	Mortality rates were low in group ≥ 80 years and QoL increased towards normal values	In octogenarians, postoperative delirium was 11.0% vs 6.2% in < 80 years; P = 0.034. Operative mortality was 1.9% vs 2.9%; P = 0.59. The QoL was impaired 30-days after surgery (PCS = 45.01, P < 0.001; MCS = 48.21, P = 0.04) but improved towards or above normal values at 1-year follow-up (PCS = 49.92, P = 0.67, MCS = 52.55, P < 0.001). Age was not associated with a lower PCS (β = 0.08 per year, P = 0.34) or MCS (β = 0.08 per year, P = 0.32) 1 year after surgery
Baron et al[29], 2017	Randomized clinical trial	To compare HRQoL among intermediate-risk patients with severe AS treated with either TAVR or SAVR	TAVR (950) and SAVR (883)	1006/827; 81.4 (6.8)	NA	KCCQ, SF-36 questionnaire and EuroQOL-5D at baseline, 1 month, 1 year, and 2 years	Improvement of health status with both TAVR and SAVR at 2 years of follow up	After 2 years of follow up, both TAVR and SAVR showed significant improvements in both disease-specific (16-22 points on the KCCQ-OS scale) and generic health status (3.9-5.1 points on the SF-36 physical summary scale)
Kotajarvi et al[34], 2017	Prospective study	To investigate QoL in patients undergoing TAVR or SAVR, and examine the extent to which patient-centered outcomes compare between frail and non-frail patients	AS (103)	61/42; 80.6 ± 7.4	NA	DASI, SF-12 questionnaire and LASA administered before and 3 months after surgery	Frail patients exhibit greater improvement in patients’ self-reported outcomes than non-frail patients	Frail patients improved in DASI and SF-12 PCS scores by 50% and 14%, respectively. SF-12 MCS scores improved in frail compared to non-frail participants (3.6 points vs < 1 point). Physical well-being and QoL measures also increased in frail compared to non-frail participants (21.6 points vs 7.1 points) and (25.1 points vs 8.7 points) respectively
Olsson et al[25], 2017	Single-center study	To describe patients’ self-reported outcomes in terms of physical function, symptoms, dependence, HRQoL, and cognitive function after TAVI and SAVR	TAVI (24) and SAVR (24)	15/9 and 12/12; 81 (range: 60-90) and 80 (61-88)	NA	Katz index of independence in ADL, SF-36 questionnaire, EuroQOL-5D and Mini Mental State Examination on the day before and at 6 months after surgery	No change in cognitive function or dependence and no difference in the size of improvement between groups at 6 months’ follow-up	Symptoms reduced, but breathlessness and fatigue remained, especially in the TAVI group. HRQoL was very low in the TAVI group at baseline but increased in all dimensions except social function
Blokzijl et al[8], 2021	Observational, multicenter, cohort study	To explore the effect of SAVR on QoL and the variance with age	SAVR (899)	583/316; NA	NA	SF-12 or SF-36 questionnaire at baseline and at 1-year follow-up	Patients after SAVR on average improve in physical and mental QoL	Physical health increased from 55 to 66 and mental health from 60 to 66
Surman et al[52], 2022	Prospective study	To report on the prospective outcomes in the areas of depression, QoL, angina, and frailty in SAVR and TAVR patients with AS	TAVR (100), SAVR (100), and CABG (100)	79/21, 80/20, 79/21; 65.94 (11.6), 82.87 (6.9), 65.90 (10.0)	NA		Improvement in PROMs and frailty in all groups by 3 months postoperative regardless of type of surgery	QoL improved within each group over 12 months (P value = 0.0001). Depression between groups (P value = 0.0395) and within each group was significant (P value = 0.0073 for SAVR and 0.0001 for TAVR). Angina was most frequent in TAVR in the QL (P = 0.0001) and PL (P = 0.0007) domains, and improvement was significant in the QL (SAVR P = 0.0010, TAVR P = 0.0001) and PL (SAVR P = 0.0002, TAVR P = 0.0007) domains in both groups. Frailty improved in both groups but was greatest in TAVR (P = 0.00126)

ADL: Activities of daily life; AS: Aortic stenosis; CABG: Coronary artery bypass grafting; DASI: Duke Activity Status Index; HRQoL: Health-related quality of life; KCCQ: Kansas City Cardiomyopathy Questionnaire; LASA: Linear analogue self-assessment; MCS: Mental component score; NA: Not available; PCS: Physical component score; PL: Physical limitation; PROMS: Patient reported outcomes; QL: Quality of life score; QoL: Quality of life; SAVR: Surgical aortic valve replacement; SF-36: Short-Form Health Survey-36; TAVI: Transcatheter aortic valve implantation; TAVR: Transcatheter aortic valve replacement.