A Prospective Study Of Risk Factors Of Quality Of Life In Patients With Adult Cardiac Disease After Surgical Treatment

【Objective】1.In this study, we determine to evaluate the feasibility of Chinese version of MOS36-item short form health survey (SF-36) in the assessment of quality of life in patientswith adult cardiac disease.2. To evaluate the quality of life and explore its proposalinfluence factors in patients with adult cardiac valve disease at three month,six monthand twelve month respectively after surgical treatment.3. To evaluate the quality of lifeand explore its proposal influence factors in patients with coronary artery disease at threemonth,six month and twelve month respectively after coronary artery bypass graft.【Methods】1. The assessment of Chinese version of SF-36in patients with adult cardiac disease:(1) A total of400hundred consecutive patients who received surgical treatment withadult cardiac disease were recruited from1stJan2010to31stDec2010in Department ofCardiothoracic Surgery, Changhai hospital. The Chinese version of SF-36was applied toevaluate the quality of life before surgery..(2) To evaluate the internal consistent reliability, construct validity, responsibility, andacceptability of Chinese version of SF-36when applied to patients with adult cardiacdisease.2. The quality of life and its proposal influence factors in patients with adult heart valvedisease after surgical treatment:(1) On the basis of preexisting data registry system for heart valve disease, aprospective set of data registry table for the clinical data and follow-up information inpatients undergoing heart valve surgery was set up by division discussion and expertcounseling, including definitions of candidate predictor variables, and to determineinclusion and exclusion criteria.(2) A consecutive series of eligible patients meet the inclusion and exclusion criteriawas recruited from1stJan2010to31stDec2010in Department of Cardiothoracic Surgery,Changhai hospital. To collect their clinical data and finish the assessment of quality of lifewith Chinese version of SF-36preoperatively.(3) To assess the quality of life and heart function at3month',6month', and12month'follow-up respectively. (4) To assess the effect of surgical treatment by apply repeated measurement tocompare the change of quality of life and heart function preoperative and postoperative.The analysis of proposal influence factors of quality of life using One-way ANOVA andmultiple linear regression analysis..3. The quality of life and its proposal influence factors in patients with coronary arterydisease after CABG:(1) On the basis of preexisting data registry system for heart valve disease,and theSTS NCD database of United States, together with CABG database of Fuwai hospital, aprospective set of data registry table for the clinical data and follow-up information inpatients with CAD undergoing CABG was set up by division discussion and expertcounseling, including definitions of candidate predictor variables, and to determineinclusion and exclusion criteria(2) A consecutive series of eligible patients meet the inclusion and exclusion criteriawas recruited from1stJan2010to31stDec2010in Department of Cardiothoracic Surgery,Changhai hospital. To collect their clinical data and finish the assessment of quality of lifewith Chinese version of SF-36preoperatively.(3) To assess the quality of life and heart function at3month',6month', and12month'follow-up respectively.(4) To assess the effect of CABG by apply repeated measurement to compare thechange of quality of life and heart function preoperative and postoperative. The analysis ofproposal influence factors of quality of life using One-way ANOVA and multiple linearregression analysis.【Results】1. The assessment of Chinese version of SF-36in patients with adult cardiac disease:(1) Reliability:the Spearman-Brown coefficient of split-half reliability is0.733. theInternal consistency reliability: the Cronbach's α coefficient of four dimension(PF,RP,BP,GH) are bigger than0.8, and three dimension(VT,RE,MH) are between0.7and0.8,only one dimension(SF) is less than0.7, which is0.648. Each dimension has a goodpositive correlation. The correlation coefficient between the dimensions were all lowerthan the internal consistency efficient of each dimension.(2) Construct validity:the Bartlett test, χ2=1276.063,P<0.0001, the sample can beanalyzed with factor analysis. KMO(Kaiser-Meyer-Olkin measure)=0.838,2common factor were extracted by factor analysis, a "physical" factor and a "mental" factor, whichcould be used to explain62.96%of the total variance. But these2common factor not inaccordance with their theoretical structure perfectly.2. the quality of life and its proposal influence factors in patients with adult heart valvedisease after surgical treatment:(1) A total of395consecutive patients were recruited in this prospective study with327of them finished follow-up at12month after surgery, and the follow-up rate was82.8%.(2) The influence of surgery on the quality of life and heart function: all of thedimensions, including PF,RP,BP,GH,VT,SF,RE,MH,HT,PCS,MCS and totQOL were increased significantly with repeated measurement Greenhouse-geisser P<0.001except BP dimension which decreased at3month'follow-up and then recovery at month'follow-up. The proportion of patients with NYHA I-II heart function wassignificantly increased with Pearsonχ2=500.661,P<0.001.(3) One way ANOVA of proposal influence factors: a total of30factors wereanalyzed. The risk factors of PCS-3were: female, DM, NYHA heart function class III-IV,a history of heart valve surgery,prolonged ICU stay；for PCS-6: female, DM, a history heart valve surgery, LVEDD≥55mm after6month of surgery; for PCS-12: female, DM,LVEDD≥55mm after6month of surgery; for MCS-3: female, DM, a history of heartvalve surgery; for MCS-6: female, DM, preoperative LVEF<50%, preoperative LVEDD55mm, LVEDD≥55mm after6month of surgery; for MCS-12: female, DM, a history ofheart failure, preoperative LVEF<50%, preoperative LVEDD≥55mm; for QOL-3: femalDM, a history of heart valve surgery, prolonged ICU stay; for QOL-6: female, DM,LVEDD≥55mm after6month of surgery; for QOL-12: female, DM, preoperativeLVEF<50%, preoperative LVEDD≥55mm, LVEDD≥55mm after6month of surgery.(4) The multiple linear regression analysis: YPCS-3=71.268+4.153Xmale—9.290XDM,F=3.987,P=0.002<0.05; YPCS-6=83.491+4.556Xmale—8.873XDM—7.997XLVEDD-6≥55mm,F=5.391,P=0.001<0.05；YPCS-12=87.177+3.582Xmale—9.326XDM—6.304XLVEDD-6≥55mm,F=4.875,P=0.000<0.05; YMCS-3=67.227+6.185Xmale—10.345XDM,F=7.936,P=0.000<0.05YMCS-6=80.289+5.344Xmale—10.852XDM,F=5.658,P=0.000<0.05；YMCS-12=82.920+4.038Xmale—7.665XDM—3.499XLVEDD-6≥55mm,F=4.228,P=0.000<0.05；YQOL-3=68.995+5.262Xmale—9.938XDM,F=5.78,P=0.000<0.05；YQOL-6=84.041+4.323Xmale—9.534XDM—6.655XLVEDD-6≥55mm,F=7.537,P=0.000<0.05； YQOL-12=85.529+4.368Xmale—8.766XDM,F=4.895,P=0.000<0.05.3. the quality of life and its proposal influence factors in patients with coronary arterydisease after CABG:(1) A total of174consecutive patients were recruited in this prospective study with144of them finished follow-up at12month after surgery, and the follow-up rate was82.8%.(2) The influence of CABG on the quality of life and heart function: all of thedimensions, including PF,RP,BP,GH,VT,SF,RE,MH,HT,PCS,MCS and totalQOL were increased significantly with repeated measurement Greenhouse-geisser P<0.001except BP dimension which decreased at3month'follow-up and then recovery at6month'follow-up. The proportion of patients with NYHA I-II heart function wassignificantly increased with Pearsonχ2=500.661,P<0.001.(3) One way ANOVA of proposal influence factors: a total of10factors were analyzed.Except female have no significant influence on MCS-3, female, DM, smoking,familyhistory of CAD, history of myocardial infraction, number of bypass graft were all have asignificant effect on PCS-3,PCS-6,PCS-12,MCS-3,MCS-6,MCS-12,QOL-3,QOL-6,QOL-12, besides, hyperlipidemia had a significant effect on PCS-6and PCS-12.(4) The multiple linear regression analysis: YPCS-3=71.918+6.076Xmale—8.166Xfamilyhistory of CAD—8.567XDM,F=8.200,P<0.001；YPCS-6=83.234+6.330Xmale—5.267Xfamilyhistory of CAD—10.714XDM—1.996X桥血管数,F=12.437,P<0.001；YPCS-12=86.068+6.050Xmale—4.847Xfamily history of CAD—10.369XDM—5.591XMI,F=11.695,P<0.001；YMCS-3=82.552—5.698Xmale—4.847Xsmoking—8.161Xfamily history of CAD—9.637XDM,F=11.602,P<0.001；YMCS-6=87.297—4.593Xsmoking—6.290Xfamily history of CAD—11.997XDM—5.419XMI,F=11.602,P<0.001；YMCS-12=90.734—3.801Xsmoking—4.013Xfamily history of CAD—11.307XDM—7.826XMI, F=17.313,P<0.001；YQOL-3=76.110+4.856Xmale—5.512Xsmoking—8.189Xfamily history of CAD—8.819XDM,F=10.225,P<0.001；YQOL-6=85.612+5.015Xmale—3.943Xsmoking—5.583Xfamily history of CAD—11.611XDM—5.331XMI,F=16.640,P<0.001；YQOL-12=88.654+4.635Xmale—3.541Xsmoking—4.287Xfamily history of CAD—11.024XDM—6.751XMI,F=17.256,P<0.001.【Conclusions】1.The Chinese version of SF-36has an acceptable reliability,validity andresponsibility when applied to evaluate the quality of life in patients with adult cardiac disease and it can be promoted in this field although the structure validity of the scale wasnot perfect.2.The quality of life and heart function can recovery to a satisfied level after thesurgery no matter the operation was cardiac valve surgery or CABG. It is reasonable forpatients who have indication of surgery should receive operation as soon as possible torecovery earlier from the lower quality of life and heart function. And the surgeon shouldpay more attention on the BP recovery during3month postoperatively.3.The risk factor of PCS-3,MCS-3,QOL-3after adult cardiac valve surgery werefemale and DM. the common risk factors of PCS-3,MCS-3,QOL-3after CABG were DMand family history of CAD; besides, female was risk factors to PCS-3and QOL-3,smoking was risk factors to MCS-3and QOL-34.The risk factor of PCS-6,QOL-6after adult cardiac valve surgery were female,DM and preoperative LVEDD≥55mm; for MCS-6, the risk factors were female and DM.To the patients who received CABG, the risk factors of PCS-6were female, DM, familyhistory of CAD, number of bypass graft; the risk factors of MCS-6were: smoking, DM,family history of CAD, history of myocardial infraction; the risk factors of QOL-6were:female, smoking, DM, family history of CAD and history of myocardial infraction.5. The risk factor of PCS-12,QOL-12after adult cardiac valve surgery were female,DM; for MCS-12, the risk factors were female, DM and preoperative LVEDD≥55mm. Tothe patients who received CABG, the common risk factors of PCS-12, MCS-12, QOL-12were DM, family history of CAD, history of myocardial infraction; besides, female wasrisk factor of PCS-12and QOL-12, and smoking was risk factor of MCS-12and QOL-12...