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J Thorac Cardiovasc Surg 2001;121:909-919
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Sociodemographic and clinical factors associated with low quality of life one year after coronary bypass operations: The Israeli Coronary Artery Bypass Study (ISCAB)

From the Department of Health Services Research, Ministry of Health,^a the Department of Social Medicine and School of Public Health, The Hebrew University and Hadassah Medical Center,^b Jerusalem, and the Department of Epidemiology, Ben Gurion University,^c Beer Sheva, Israel.

Supported by the Ministry of Health, Israel.

Received for publication June 21, 2000. Accepted for publication Sept 22, 2000. Address for reprints: Elisheva Simchen, MD, MPH, School of Public Health, Hadassah Medical Center, Ein Kerem, Jerusalem 91120, Israel (E-mail: sara.sachs{at}moh.health.gov.il or esimchen@vms.huji.ac.il).

Objectives: We sought to examine the effect of sociodemographic characteristics and perioperative clinical factors 1 year after coronary bypass operations on low health-related quality of life. We also sought to assess the usefulness of an additional single question on overall health for identifying patients with low health-related quality of life.
Methods: This report is part of the Israeli coronary artery bypass study of 1994, in which every patient undergoing isolated coronary bypass grafting in Israel was included. The target population for this report comprised all survivors beyond 1 year who were 45 to 65 years of age. Patients were interviewed before the operations. Self-administered questionnaires regarding health-related quality of life (SF-36) were sent to 1724 patients who were successfully located 1 year postoperatively, and 1270 questionnaires were completed. Low health-related quality of life was defined as the lowest tertile of the distribution of scores for the 2 summary components of the SF-36 and the single question on overall health. Logistic models were constructed for each of the 3 outcomes.
Results: Female sex and low socioeconomic background were associated with low health-related quality of life in the logistic models. Other significant factors were symptoms of angina, sleep disturbances, hypertension, high severity of illness scores, hospital readmission, no rehabilitation, and hospitals with high perioperative mortality. Of the 3 study outcomes, the model for the single question on overall health was the most discriminating (C statistic = 0.76 vs 0.70 and 0.70, respectively).
Conclusions: The study identifies patients who would most benefit from posthospitalization community support after bypass operations. Under circumstances of limited resources, these disadvantaged groups should be targeted as a priority. Encouraging participation in existing rehabilitation programs or introducing telephone hotlines could improve health-related quality of life after coronary bypass grafting without large investments.

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