Morbidity and mortality in patients waiting for coronary artery bypass surgery

Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
European Journal of Cardio-Thoracic Surgery (Impact Factor: 3.3). 04/2001; 19(3):260-5. DOI: 10.1016/S1010-7940(01)00580-2
Source: PubMed

ABSTRACT To describe morbidity and mortality in patients waiting for coronary artery bypass graft (CABG) surgery and to assess determinants for the occurrence of these complications.
A prospective cohort study was carried out in a tertiary referral general teaching hospital. Three hundred and sixty consecutive patients with a priority of routine or urgent who were accepted for CABG or CABG with additional valve surgery were evaluated. Follow-up began from the moment of acceptance until the procedure took place for cardiac death, myocardial infarction and unstable angina requiring hospital admission.
The median (25-75th percentile) waiting time in the two priority groups was 100 (79-119) days for the routine group and 69 (38-91) days for the urgent group. Overall, eight patients died, seven suffered a myocardial infarction, and 33 episodes of unstable angina requiring immediate hospitalization occurred. The majority of events took place during the first 30 days on the waiting list. Unstable angina less than 3 months before acceptance was identified as an independent predictor (hazard ratio 2.5, 95% confidence interval 1.2-5.1) for complications during the wait. The prognostic value of smoking and familial cardiovascular disease was found to vary depending on the priority assigned to the patient.
Complications occur relatively early during the time on the waiting list. If complications in coronary heart disease cannot be predicted more accurately, the only way to diminish the complication rate is drastic reduction of waiting times.

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Available from: Jan J Piek, Feb 05, 2014
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    • "A waiting time refers to the length of time between when the patient is placed on a waiting list for CABG and when the surgery is eventually performed. The median of the waiting times, in Western societies, ranges from 55 days to 6 months (Koomen et al. 2001, Rexius et al. 2005), with a reasonable portion of the patients is waiting longer than 12 months (Cesena et al. 2004). With delayed CABG, significant mortality (Rexius et al. 2005) and morbidity (Fitzsimons et al. 01/2000) may occur. "
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    ABSTRACT: Background: Coronary artery bypass graft surgery improves quality of life and survival rates. However, prolonged waits for this surgery are inevitable in countries having nationalized healthcare systems. Although no significant decline in the waiting times for this surgery has been demonstrated, recent research in psychological experiences of the patients is lacking Objectives: 1) To describe psychological experiences, anxiety and uncertainty, and quality of life in Omani patients awaiting coronary artery bypass graft. 2) To examine the significance of sociodemographics, health characteristics and the waiting time in predicting anxiety and uncertainty. 3) To examine the independent effect of anxiety and uncertainty in predicting quality of life of the patients. Methods: This study used a cross-sectional design. To obtain the required information, two nurses interviewed a convenience sample of hospitalized patients for coronary artery bypass graft (N = 84) between May 2011 and June 2012. Three regression analyses were used to identify significant predictors of anxiety, uncertainty and quality of life. Results: Literate patients and those with infrequent hospital admissions were more likely to experience high levels of anxiety, whereas, patients without myocardial infarction but having hypertension, and those who waited for the surgery 60 days or less were more likely to report greater uncertainty. Exercising regularly, low family monthly income and short duration since diagnosis with coronary artery disease significantly predicted better quality of life Conclusion: Physiological disruptions and concomitant chronic illnesses have significant effects on the psychological experiences and quality of life of the patients.
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    • "As the progression of CAD continues during the waiting time, it is possible for the CAD patients to experience adverse coronary events, such as unstable angina and myocardial infarction , while being waitlisted for CABG. In addition, patients have to deal with other symptoms of ischemic heart disease and heart failure, such as angina, dyspnea, and fatigue (Bengtson et al., 1996; Koomen et al., 2001). Banner (2010) showed this waiting period to be a time of uncertainty that causes psychological and social problems, complicated by deteriorating health, worsening functional limitations, and growing fears of death and disability.The patients in Banner's study also revealed that fear of death, especially after having a heart attack, was their main concern. "
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    ABSTRACT: This qualitative descriptive study, underpinned by the naturalistic inquiry, explored the lived experiences of individuals awaiting coronary artery bypass grafting in Thailand. Eleven northern Thai individuals volunteered to participate. Data were gathered through in-depth interviews and analyzed using content analysis. Two major themes arose: uncertainty of life and striving to balance well-being. The first of these themes is presented in this paper. Uncertainty of life was recognized as a dynamic emotional state of being unsure or insecure in life, but its occurrence depended on the individual situation; it was described through two subthemes that had a profound effect on the participants: fear of death and fear of disability. Participants' uncertainty of life encompassed being unsure about the risks of dying from illness, both prior to and following the surgery, and surviving the surgery with a disability. These findings provide insight into the experiences of individuals awaiting coronary artery bypass grafting and will assist nurses and other healthcare providers in creating timely programs and appropriate interventions to reduce uncertainty of life while awaiting surgery.
    Nursing and Health Sciences 06/2013; 15(4). DOI:10.1111/nhs.12058 · 1.04 Impact Factor
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    • "However, long delays of needed treatment have raised public and political concern, as they could entail diverse negative consequences for patients [6] and subsequently pose a threat to the quality of care. Studies among patients waiting for cardiac or orthopaedic surgery have for instance shown that waiting is associated with deterioration of symptoms [7,8], affected quality of life [8,9] and even death of listed patients [10,11]. Moreover, waiting for treatment is found to cause anxiety, distress and uncertainty among patients [12], and entails prolonged sick leave [13] and loss of income [14,15]. "
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    ABSTRACT: Long waiting times for elective surgical treatment threaten timely care provision in several countries. The purpose of this study was to assess the impact of waiting for elective general surgery on the quality of life and psychosocial health of patients. A cross-sectional questionnaire study with postoperative follow-up was performed among patients on waiting lists for surgical treatment of varicose veins (n = 176), inguinal hernia (n = 201), and gallstones (n = 128) in 27 hospitals. In each group the waiting period involved worse general health perceptions (GHPQ), more problems in quality of life (EuroQoL), and raised levels of anxiety (STAI) as compared to after surgery (all differences: p < 0.05). Quality of life was not affected in 19-36% of patients. Emotional reactions to waiting were most negative among patients with gallstones. Prior information about the duration of the wait reduced the negativity of these reactions (p < 0.05). Social activities were affected in 39% to 48% of the patients and 18%-23% of employed patients reported problems with work during the wait. Having waited a longer time was associated with worse quality of life among patients with inguinal hernia. Longer waited times also engendered more negative reactions to waiting among patients with inguinal hernia and gallstones (multilevel regression analysis, p < 0.01). Waiting for general surgery mainly involves a prolonged period of decreased health and an affected psychological and social life of the patient in waiting. Variation in the severity of these consequences across patients indicates that the prioritisation of patients could reduce the overall burden of waiting. Early information about the duration of the delay could further promote a patient's acceptance of waiting.
    BMC Public Health 02/2007; 7(1):164. DOI:10.1186/1471-2458-7-164 · 2.26 Impact Factor
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