Reference study type (quality of study: USPSTFQR score) | Surgery: average age | Number in study (survivors, % assessed for QoL) | QoL tool | Length of follow-up | Outcome |
---|---|---|---|---|---|
Fruitman et al25 Retrospective (Fair quality) Nova Scotia, Canada | All cardiac surgery Mean 83±2.5 (80–92) | 127 (103, 96.1%) | SF-36 SAQ | Mean 15.7 (4.7–27.7) months | SF-36 scores were equal to or better than those for the general population 83.7% living in their own home, 74.8% rated their health, as good or excellent, 82.5% would undergo operation again |
Kurlansky et al26 Retrospective (Good quality) Florida, USA | CABG Mean 83.1±2.8 (80–99) | 1062 (555, 98.2%) | SF-36 | Mean 3.4 (0.1–12.6) years | SF-36 scores comparable to age-adjusted norms in mental and physical summary scores |
Sjogren et al27 Retrospective (Fair quality) Lund, Sweden | All cardiac surgery Mean 81.8±2.3 (80–91) | 117 (41, 95%) | SF-36 | Mean 8.3 ±1.9 years | QoL comparable to age-matched population, lower physical function, but less bodily pain in study population |
Vicchio et al 28 Retrospective (Fair quality) Naples, Italy | AVR± CABG BP: Mean 82.9±2.7 MP: Mean 81.8±1.8 | 160 (125, 97.6%) | SF-36 | Mean 3.4±2.8 years | Scores higher than age-matched and sex-matched Italian population in all domains other than vitality |
Collins et al29 Retrospective (Fair quality) Stockholm, Sweden | All cardiac surgery Mean 81.9±1.3 (80–84) | 183 (155, 94.2%) | SWED-QUAL | 1–6 years | Patients had significantly better physical functioning, satisfaction with physical functioning, relief of pain and emotional well-being (p=0.01) compared to the normal population |
Kurlansky et al30 Retrospective (Good quality) Florida, USA | CABG (Arterial vs SVG) SVG: Mean 83.5±3.0 (80–99) ART+SVG: Mean 82.5±2.5 (80–92) | 987 Arterial (247/97%) SVG (247/98.8%) | SF-36 | Arterial 3.8 years (0.4–12.6) SVG 3.1 (0.2–11.2) | Patients with arterial grafts scored significantly higher than SVG patients and age-adjusted normal participants |
Ghanta et al31 Retrospective (Good quality) Massachusetts, USA | CABG, AVR±CABG Mean 82 (80–94) | 459 (158, 72%) | SF-12 | Median 7.9 years | Survivors’ median quality of life mental health score was higher (55.2 vs 48.9; p<0.05) and physical health score was equivalent (39.3 vs 39.8; p=0.66) to the general elderly population |
Krane et al32 Retrospective (Fair quality) Munich, Germany | CABG, AVR±CABG Mean 82.3 (80–94) | 1003 (514, 75.1%) | SF-36 | Mean 3.62±2.42 years | Physical functioning 49.7; role-emotional 58.5; social functioning 76.2; mental health 69.7, bodily pain 70.5, vitality 48.7, role-physical 43.6, general health 55.5. Bodily pain, general health higher than age-matched population (p<0.01). Role-physical and role-emotional lower (p<0.02) Summarised physical health score increased (p<0.05) compared with the general population, the mental health summarised scores showed no difference |
Sundt et al33 Retrospective (Fair quality) St Louis, USA | AVR±other cardiac procedure Mean 83.5±2.6 (80.1–90.6) | 133 (65, 98%) | SF-36 | Up to 5 years | SF-36 scores comparable to general population >75. Participants scored higher than the control population in 5 areas; bodily pain, general health, social functioning, role-emotional and mental health |
Schonebeck et al34 Retrospective (Conference abstract) Hamberg, Germany | All cardiac surgery Mean 82±2.5 | 107 (Not specified) | SF-36 | Not specified | Lower scores for physical functioning (37±10.5), general health (44.1±11.0), physical role (41.0±7.8), and physical component summary (44.7±9.3) compared to the normal population (p=0.001) |
Ghosh et al35 Retrospective (Fair quality) Salzburg, Austria | All cardiac surgery Mean 82.2±1.8 | 212 (186, not specified) | EQ-5D | Mean 40.2 (2–144) months | Concluded excellent postoperative QoL. Mean EQ-5D score of 6.5. Score slightly poorer in women (6.7), than men (6.2) |
Spaziano et al36 Retrospective (Fair quality) Quebec, Canada | Valve replacement Mean 82 (80–89) | 133 (118, 64.4%) | SF-12v2 MLHFQ | Mean 2.0±1.1 years | Men similar to age-matched population. Women similar in physical component scale but lower mental component. Data from MLHFQ revealed worse QoL in females than in males, both on the physical and emotional scales |
Aboud et al37 Retrospective (Fair quality) Jena, Germany | AVR Not documented | <53 (Not specified) | SF-36 | Mean 21.4 months (18–24) | SF-36 scores better in bodily pain, mental health, social functioning, role emotional in patients >80 |
Sen et al38 Retrospective (Good quality) Giessen, Germany | CABG Mean 82.3±2.13 | 240 (97.1%) | SF-12 | Mean 53 months | Four years after surgery, 95.2% of the octogenarians lived alone, with a partner or with relatives, and only 4% required permanent nursing care. 83.9% of the octogenarians would recommend surgery to their friends and relatives for relief of symptoms. Mental component scores higher than physical component scores and overall summary scores lower than in a younger age group |
Nydegger et al39 Retrospective (Conference abstract) Zurich, Switzerland | All cardiac surgery Mean 82.2±2.7 | 53 (Not specified) | SF-36 | 1 year | Physical function (p=0.002) and the physical component summary (p=0.03) were lower in patients >80. The mental component summary was similar between both groups (compared with patients <80) |
Levin et al40 Retrospective (Poor quality) Lund, Sweden | AVR±CABG >85 Mean 86.5±1.5 (85–91) | 21 (13, 100%) | SWED-QUAL | 9–83 months | Significant improvement in physical functioning, satisfaction with physical ability, sleep, health status and perception of general health |
Folkman et al41 Retrospective (Fair quality) Vienna, Austria | AVR±CABG Mean 82.9±2.5 | 154 (126, 100%) | SAQ | 1 year | Improvement in QoL in 96% reduction in physical fitness in 33% |
Huber et al42 Retrospective (Fair quality) Inselspital, Switzerland | CABG, AVR±CABG Mean 82.3±2.1 (80–91) | 136 (120, 100%) | SAQ | Mean 890 (69–1853) days | 81% had no or ‘little’ disability in ADL, 65% very satisfied with QoL |
Graham et al43 Retrospective (Fair quality) Calgary, Canada | CABG (compared with PCI and medical mx) Median 81.8 | 66 at 1 year 55 at 3 years | SAQ | At 1 and 3 years | All domains (angina stability, angina frequency, QoL, treatment satisfaction) other than exertional capacity significantly better with CABG than medical management, at both 1 and 3 years |
Kamiya et al44 Retrospective (Poor quality) Tokyo, Japan | CABG+PCI Mean 82.1±2.1 | 28 (15, 100%) | Self-designed based on SAQ | Mean 39.9±30.1 months | 80% no limitation dressing, 66.7% no or little limitation walking 300 m, 86.7% satisfied with their treatment |
Nikolaidis et al45 Retrospective (Fair quality) Southampton, UK | AVR±CABG Mean 82.9±2.3 | 345 (279, 62%) | Self-designed questionnaire | Mean 39.3±29 months | 83.7% satisfied with operation outcome, 82% independent personal care, 88.3% had positive feelings about life |
Tsai et al46 Retrospective (Fair quality) California, USA | All cardiac surgery Mean 83.1±2.7 (80–94) | 528 (Not specified) | Self-designed questionnaire | 6 months | 70% improved QoL, 18% same, 12% worse. 38% active lives, 26% sedentary, 35% restricted |
Schmidtler et al47 Retrospective (Good quality) Munich Germany | All cardiac surgery Mean 82.6±2.9 (80–93) | 641 (227/90%) | Self-designed questionnaire | Mean 3.6 (0.1–11.8) years | At mid-term follow-up QoL had improved in 54%, there was no difference in 31% and was impaired in 15%. 80% of all surviving patients lived in their own home |
Maillet et al48 Retrospective (Fair quality) Saint-Denis, France | AVR±CABG Mean 83.7±3.3 (80–94) | 84 (51/100%) | Self-designed questionnaire | Mean 723±404 days | 91.1% living in their own homes, Self-rated health ‘excellent’ or ‘good’ in 76.8%, 66.1% reported health had improved postoperatively, 60.7% would have operation again, 26.7% required help for ADL. 17.8% felt autonomy was worse postoperatively |
Goyal et al49 Prospective (Fair quality) Victoria, Australia | All cardiac surgery Mean 82.4 (80–94) | 100 (80,85%) | Self-designed questionnaire | 6–60 months | 86.76% were less dependent on others, 13.23% felt their dependence on social support had increased, 80.9% were feeling well and looking positively to the future, 94.2% patients would have the procedure again, in retrospect, 41.2% lived alone |
Kirsch et al50 Retrospective (Fair quality) Creteil, France | All cardiac surgery Mean 83±2.7 (80–91) | 191 (129, 97%) | Self-designed questionnaire | Mean 22.24 (0–73.3) months | 64% of long-term survivors fully autonomous, female sex only independent predictor of impaired autonomy, 83% satisfied with QoL |
Kolh et al51 Retrospective (Fair quality) Liege, Belgium | AVR Mean 82.8±2.4 (80–94) | 220 (59%) | Self-designed questionnaire | Mean 58.2 months | 91% believed that having heart surgery after age 80 years was a good choice, and similarly 88% felt as good as or better than they had preoperatively |
Hewitt et al52 Retrospective (Fair quality) Perth, Australia | All cardiac surgery Mean 8.13±1.2 (80–88) | 64 (44/100%) | Modified SF-36 (16 questions) | 1 month, 1 year, final+mean 2.8±0.8 years | 98% thought surgery was worthwhile and would recommend to a friend and 86% were living independently |
Diegeler et al53 Retrospective (Fair quality) Gottingen, Germany | All cardiac surgery Mean 82.2±1.79 (80–87) | 54 (43, 100%) | Self-designed questionnaire | Mean 26.2±16.54 (6–91) months | Of 43 survivors 41 lived independently, 38 capable of ADLs without help. 40 of the 43 survivors described significant improvement in their QoL |
Ennker et al54 Retrospective (Fair quality) Baden, Germany | Stentless AVR Mean 82±2 | 76 (Not specified) | Nottingham health profile | Mean 35±23 months | QoL equal to or better than general population. Women had slightly lower QoL than men |
Kumar et al55 Retrospective (Fair quality) Baltimore, USA | All cardiac surgery Group 1 Mean 83.2±2.2 (80–87) Group 2 Mean 83.0±2.0 (80–89) | Group 1:15 (8/100%) Group 2: 52 (38/100%) | Karnofsky performance score Self-designed questionnaire | Mean 1.5 years | Improvement in QoL, 75% group 1 and 84% group 2, would have operation in retrospect. Mean Karnofsky dependency category decreased from 2.0±0.4 to 1.5±0.5 p<0.01 |
NNwaejike et al56 Retrospective (Fair quality) Maryland, USA | All cardiac surgery Mean 82.4±1.28 (80–88) | 66 (Not specified) | Barthel Index | Not specified | Mean Barthel Index 17.7 (min 0, max 20) |
Chaturvedi et al57 Retrospective (Good quality) Quebec, Canada | All cardiac surgery Mean 82.5 (80–92) | 300 (188, 100%) | Barthel Index Karnofsky performance score | Up to 5 years | At 3.6 years: 64.9% autonomous, 28.1% semiautonomous, and 9.2% dependent. 71.8% were at home, 21.2% in a residence, and 6.9% in a supervised setting |
Leung et al58 Retrospective (Fair quality) Quebec, Canada | Valve surgery±CABG Mean 8.5 (80–92) | 185 (110, 100%) | Karnofsky performance score Barthel Index | Mean 38 (7–78) months | 66% autonomous, 26% semiautonomous, 8% dependent 72% living at home, 19% in residence, 9% in a supervised nursing facility |
Caus et al59 Retrospective (Fair quality) Ottawa, Canada | AVR Not documented | 101 (61, not specified) | Karnofsky performance score | Mean 2.7 years per patient | Mean Karnofsky score 61 |
ADL, activities of daily living; AVR, aortic valve replacement; CABG, coronory artery bypass graft; MLHFQ, Minnesota Living with Heart Failure Questionnaire; PCI, percutaneous coronary intervention; QoL, quality of life; SAQ, Seattle Angina Questionnaire; SF-36, Short Form 36; SVG, Saphenous vein grafts; SWED-QUAL, The Swedish health-related quality of life survey.