Quality of life dynamics in cardiac surgery patients during the first year after open heart surgery: results of single center observational study

Rationale. Improving the quality of life (QoL) as well as restoration of physical, emotional and mental functioning is the key goals of treatment in patients with coronary heart disease (CAD) and acquired heart defects (AHD). Data on terms, dynamics and features of improving various aspects of QoL after open heart surgery in these groups of patients are currently limited. In addition, the relationship between clinical and instrumental preand postoperative data and the dynamics of changes in quality of life has not been established.

Aim. To study the dynamics of QoL and the degree of satisfaction with the results of treatment in patients with CAD and AHD during 12 months after open heart surgery.

Material and Methods. Adult patients with CAD and AHD requiring surgical treatment were enrolled in the study. Before surgery, all the patients underwent a standard clinical, laboratory and instrumental examination as part of the cardiac surgical treatment protocol, supplemented by determining the level of B-natriuretic peptide (NP) before surgery and on the day of discharge from the hospital. Within 12 months after discharge from the hospital, a control echocardiographic study was performed. To assess QoL, patients filled in the RAND SF-36 and SAQ questionnaires before surgery, at 3, 6 and 12 months after discharge. Treatment satisfaction was assessed 3, 6 and 12 months after surgery. The analysis of changes in QoL after surgery was carried out using Generalized estimating equations; the time after surgery, gender, age, population of the place of residence, duration of the disease, the level of NP before surgery and the dynamics of LVEF 12 months after surgery were considered as independent variables.

Results. Totally, 189 (63.9%) patients with CAD and 107 (36.1%) patients with AHD (median age 65 years, men – 68%), who underwent open heart surgery from November 2022 to January 2024 were enrolled. The median pre-surgery NP level was 243 pg/mL in the CAD group and 812 pg/mL in the AHD group. In the vast majority of patients, the LV EF increased after 12 months (CAD, n = 49 [25.9%], AHD, n = 24 [22.4%]) or remained unchanged (CAD, n = 139 [73.5%], AHD, n = 82 [76.6%]). At 12 months after surgery, 87% of patients with CAD and 90% of patients with AHD reported an improvement in well-being; 98% of patients with CAD and 96% of patients with AHD are satisfied with the degree of elimination of symptoms of the disease. The positive dynamics of general aspects of QoL was less pronounced in both groups in men and in patients younger than 55 years; in patients with CAD – in the early postoperative period if they had no significant increase in LV EF 12 months after surgery, as well as if they had preoperative level of NP > 1200 pg/ml.

Conclusion. Significant QoL improvement in both CAD and AHD patients was observed already in 3 months after open heart surgery, with further sustained positive dynamics at 6 and 12 months. The vast majority of patients were satisfied with heart surgery. Sociodemographic factors – age, gender, population of the place of residence, as well as clinical factors – duration of the disease, baseline level of NP, dynamics of LVEF is associated with QoL changes during the first year after surgery.

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