Article

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: 2.81). 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.

Download full-text

Full-text

Available from: Jan J Piek, Feb 05, 2014
0 Followers
 · 
71 Views
  • Source
    [Show abstract] [Hide abstract]
    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.
  • Source
    Canadian Medical Association Journal 09/2005; 173(4):382-3. DOI:10.1503/cmaj.050704 · 5.81 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait lists at the time of registration for the operation. The study cohort included 8966 patients who registered to undergo isolated coronary-artery bypass grafting (82.4% men; 71.9% semi-urgent; 22.4% non-urgent). The patients were categorized according to wait-list clearance time at registration: either "1 month or less" or "more than 1 month". Cumulative incidence for wait-list death was compared between the groups, and the significance of difference was tested by means of regression models. Urgent patients never registered on a wait list with a clearance time of more than 1 month. Semi-urgent patients registered on shorter wait lists more often than non-urgent patients (79.1% vs. 44.7%). In semi-urgent and non-urgent patients, the observed proportion of wait-list deaths by 52 weeks was lower in category "1 month or less" than in category "more than 1 month" (0.8% [49 deaths] vs. 1.6% [39 deaths], P < 0.005). After adjustment, the odds of death before surgery were 64% higher in patients on longer lists, odds ratio [OR] = 1.64 (95% confidence interval [CI] 1.02-2.63). The observed death rate was higher in category "more than 1 month" than in category "1 month or less", 0.79 (95%CI 0.54-1.04) vs. 0.58 (95% CI 0.42-0.74) per 1000 patient-weeks, the adjusted OR = 1.60 (95%CI 1.01-2.53). Longer wait times (log-rank test = 266.4, P < 0.001) and higher death rates contributed to a higher cumulative incidence for death on the wait list with a clearance time of more than 1 month. Long wait lists for coronary-artery bypass grafting are associated with increased probability that a patient dies before surgery. Physicians who advise patients where to undergo cardiac revascularization should consider the risk of pre-surgical death that is associated with the length of a surgical wait list.
    Journal of Cardiothoracic Surgery 02/2006; 1:21. DOI:10.1186/1749-8090-1-21 · 3.05 Impact Factor