Gender differences in health-related quality of life after coronary bypass surgery: results from a 1-year follow-up in propensity-matched men and women.

OBJECTIVE: To examine whether the predictive value of gender for health-related quality of life (HRQoL) is independent of clinical health status and depression. Women undergoing coronary bypass surgery generally report a poorer HRQoL than men. METHODS: A total of 990 (20% women) patients completed study questionnaires 1 day before coronary bypass surgery and 1 year after surgery. Physical aspects of HRQoL were assessed with the Short Form 36 Health Survey. Depression was measured with the self-reported Patient Health Questionnaire. Propensity score matching was applied to match men and women with respect to 65 clinical variables. Of 198 women, 157 (79.3%) could be matched to a partner, resulting in an excellent balance of clinical variables between the matched groups. RESULTS: At baseline, propensity-matched men and women differed in physical functioning (p < .001) and role functioning (p = .007), but not in bodily pain and general health perception. In both men and women, HRQoL outcomes improved over 1 year. Preoperative depression predicted worse physical HRQoL in all outcomes, except general health perception 1 year after surgery. After adjusting for depression, gender lost its predictive power with respect to physical functioning. However, compared with women, men still reported a better role functioning. CONCLUSION: Our data suggest that gender is a marker for role functioning, independent of the clinical health status and depression. Rehabilitation measures designed for the specific needs of women might help to improve their HRQoL.

Causal attributions among patients undergoing coronary artery bypass surgery: gender aspects and relation to depressive symptomatology.

Causal attributions made by patients for their coronary heart disease may contribute to gender differences in emotional adjustment. The purpose of this study was to determine gender differences in causal attributions and to analyze the associations between causal attributions and depressive symptomatology in patients undergoing coronary artery bypass graft (CABG) surgery. Nine hundred and seventy-nine patients (mean age 66.8 years, 19.9% women) completed a modified version of the Illness Perception Questionnaire (IPQ) and the depression module of the Patient Health Questionnaire (PHQ-9) 1-3 days before CABG-surgery and 1 year after surgery. Men were more likely to name their health behavior (men: 40.2%, women: 26.9%, P < .001) as a cause of disease, whereas women were more likely to cite destiny (women: 34.7%, men: 25.7%, P = .012). Regression analyses showed cross-sectional and longitudinal associations of attributions with depressive symptomatology which were independent of gender, sociodemographic and clinical variables. Attribution to personality and stress were associated with an increase in depressive symptomatology. Causal attributions may present a valuable approach for identifying patients at risk for depression and the implementation of targeted interventions.

Regression of myocardial hypertrophy after aortic valve replacement: faster in women?

BACKGROUND: In patients with aortic stenosis, pressure overload induces cardiac hypertrophy and fibrosis. Female sex and estrogens influence cardiac remodeling and fibrosis in animal models and in men. Sex differences and their molecular mechanisms in hypertrophy regression after aortic valve replacement have not yet been studied. METHODS AND RESULTS: We prospectively obtained preoperative and early postoperative echocardiography in 92 patients, 53 women and 39 men, undergoing aortic valve replacement for isolated aortic stenosis. We analyzed in a subgroup of 10 patients matrix gene expression in left ventricular (LV) biopsies. In addition, we determined the effect of 17ß-estradiol on collagen synthesis in isolated rat cardiac fibroblasts. Preoperatively, women and men had similar ejection fraction. Similar percentages of women and men had increased LV diameters (37% and 38%). Women more frequently exhibited LV hypertrophy than men (women: 86%; men: 56%; P<0.01). Postoperatively, increased LV diameters persisted in 34% of men but only in 12% of women (P<0.023). LV hypertrophy reversed more frequently in women than in men, leading to a similar prevalence of LV hypertrophy after surgery (women: 45%; men: 36%). In surgical biopsies, men had significantly higher collagen I and III and matrix metalloproteinase 2 gene expression than women. In isolated rat cardiac fibroblasts, 17ß-estradiol significantly increased collagen I and III gene expressions in male cells but decreased it in female cells. CONCLUSIONS: Women adapt to pressure overload differently from men. Less fibrosis before surgery may enable faster regression after surgery.

Screening for depression: Rasch analysis of the dimensional structure of the PHQ-9 and the HADS-D.

BACKGROUND: Both the depression modules of the Hospital Anxiety and Depression Scale (HADS-D) and the Patient Health Questionnaire (PHQ-9) are widely used for the screening of depression. We analyzed the dimensionality and the item fit of both scales individually and across the scales. Moreover, we sought to identify items which evidenced item response bias associated with age and gender. METHODS: The depression subscales HADS-D and the PHQ-9 were administered to 1271 patients (mean age 67.2; 22.5% women) undergoing coronary artery bypass graft surgery (CABG). Rasch analyses were performed to assess the overall fit of the model, individual item fit and differential item functioning (DIF). RESULTS: Rasch analysis revealed that the HADS-D and the PHQ-9 feature a common core construct containing six items of the HADS-D and three items of the PHQ-9. Two of these items are identical with the 2-item short form of the PHQ-9. In addition, fatigability was the only somatic item that fitted the model. No substantial DIF was observed. LIMITATIONS: The generalizability of these results might be restricted to patients awaiting CABG. CONCLUSIONS: The short form of the PHQ-9 seems to be an economic and valid instrument for the screening of depression, which indicates the same latent construct that is captured by six items of the HADS-D. Further studies are needed to evaluate whether the addition of fatigability might enhance the validity of the PHQ-2 in this patient population.

Predictors of preoperative depressive risk in patients undergoing coronary artery bypass graft surgery.

AIMS: Depression is highly prevalent among patients undergoing coronary artery bypass graft (CABG) surgery and represents a significant risk factor for longer hospitalization, increasing health costs and worse outcomes. Nonetheless, preoperative depression is rarely assessed in clinical practice, limiting the possibilities for effective prevention and care. Thus, we sought to develop risk models to determine the depressive risk before CABG based on sociodemographic, clinical and treatment variables. METHODS AND RESULTS: One thousand two hundred and thirty-eight CABG-patients completed the 9-item Patient Health Questionnaire (PHQ-9) prior to surgery. Clinical and sociodemographic data were collected by trained study investigators. Overall 21.6% of patients displayed elevated depression scores, which were twice as common in women than in men (34.7 versus 17.9%, P < 0.001). Following bivariate analysis, multiple regression revealed that both dyspnea at rest (OR 1.69, 95% CI 1.11-2.57, P = 0.015) and dyspnea on exertion (OR 2.48, 95% CI 1.61-3.81, P < 0.001), previous myocardial infarction (OR 1.53, 95% CI 1.12-2.08, P = 0.007), comorbidities and medication with tranquillizers; in addition to younger age, female gender, lower school education, and living alone are significantly and independently associated with preoperative depressive symptoms. CONCLUSIONS: Knowledge of these risk factors will allow for better identification of patients at high depressive risk and thereby facilitate optimal treatment in order to improve postoperative outcomes.

Does time spent on household activities or housework stress complicate recovery following coronary artery bypass surgery?

OBJECTIVES: The purpose of the present study was to examine the role of household activities and housework stress as factors contributing to gender differences in recovery following coronary artery bypass graft (CABG) surgery. Therefore, the impact of time spent on household activities and housework stress on physical functioning (PF) was explored. METHODS: Psychosocial data were measured two months and again one year after CABG in a sample of 351 patients (23% women) recruited within one week before surgery. Self-report questionnaires included assessment of household responsibilities, depression (PHQ-9), and PF (SF-36 subscale). RESULTS: The results revealed that, following CABG, women spent more time on household activities and experienced markedly more stress due to these activities than men. Surprisingly, only housework stress was associated with poorer PF, whereas the time spent on household activities did not explain differences in PF in men and women. Finally, household responsibilities were not associated with the poorer recovery of the female CABG patient. DISCUSSION: In conclusion, our results do not support the advice that women should not resume household activities two months after surgery. More research is needed to establish valid guidelines.