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Cardiac surgery
Original research article
Disability–free survival after coronary artery bypass grafting in women and men with heart failure
  1. Louise Y Sun1,2,
  2. Jack V Tu2,3,
  3. Douglas S Lee2,4,
  4. Rob S Beanlands5,
  5. Marc Ruel6,
  6. Peter C Austin2,
  7. Anan Bader Eddeen2 and
  8. Peter P Liu5
  1. 1 Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  2. 2 Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Ontario, Canada
  3. 3 Sunnybrook Schulich Heart Centre, University of Toronto, Toronto, Ontario, Canada
  4. 4 Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
  5. 5 Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  6. 6 Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Louise Y Sun; lsun{at}ottawaheart.ca

Abstract

Objective Heart failure (HF) impairs survival post coronary artery bypass grafting (CABG), but little is known about the postoperative quality of life (QoL) in patients with HF. We derived a patient-centred QoL surrogate and assessed the impact of different HF subtypes on this surrogate in the year post-CABG.

Methods We surveyed 3112 cardiovascular patients to derive a patient-centred disability outcome and studied this outcome in a population-based cohort. We defined preserved ejection fraction as ≥50% and reduced ejection fraction as <50%. The primary outcome was disability, defined according to compiled patient-derived values. The secondary outcomes consisted of each individual component of disability, and death. The incidence of disability was calculated using cumulative incidence functions, with death as a competing risk. We identified predictors of disability using cause-specific hazard models.

Results Patient-derived disability outcome consisted of stroke, nursing home admission and recurrent hospitalisations. When applied to 40 083 CABG patients (20.6% women), the incidence of disability was 5.4% while the incidence of death was 3.7% in the year post-CABG. Female sex was associated with an adjusted HR of 1.25 (95% CI 1.13 to 1.37) for disability. Women with HF with preserved ejection fraction had an adjusted HR of 1.73 (95% CI 1.52 to 1.98) for disability.

Conclusions Disability was a more frequent complication than death in the year post-CABG. Women experienced higher burden of disability than men, and female sex and the presence of HF were important disability risk factors. Efforts should be dedicated to disability risk prediction to enable patient-centred operative decision-making and to developing sex-specific treatment strategies to improve outcomes.

  • coronary artery bypass grafting
  • heart failure
  • quality of life
  • disability
  • survival
  • Patient-centered outcomes

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2018-000911

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    Footnotes

    • Contributors LYS contributed to the conception and design of the work, and obtained funding for the study. All authors contributed to the design of the work. LYS and ABE contributed to the acquisition and analysis of data. All of the authors contributed to the interpretation of data. LYS contributed to drafting of the manuscript, which all of the authors revised. All of the authors agree to be accountable for all aspects of the work, including the accuracy and integrity of the data presented.

    • Funding We acknowledge support from an operating grant from the University of Ottawa Department of Anesthesiology and Pain Medicine (Grant #4566). JVT was supported by a Canada Research Chair in Health Services Research and a Career Investigator Award from the Heart and Stroke Foundation of Ontario. DSL is supported by a mid-career investigator award from the Heart and Stroke Foundation and is the Ted Rogers Chair in Heart Function Outcomes. PCA is supported by a Career Investigator Award from the Heart and Stroke Foundation. The funders do not have a role in the design and conduct of the study, in the collection, analysis and interpretation of the data, nor in the preparation, review or approval of the manuscript.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The University of Ottawa Heart Institute Research Ethics Board approved the survey study. The Research Ethics Board of Sunnybrook Health Sciences Centre, Toronto, Canada, approved the population-based study and waived the need for informed consent.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement The data and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure.