ABSTRACT
Candidates for cardiac bypass surgery often experience cognitive decline. Such decline is likely to affect their everyday cognitive functioning. The aim of the present study was to compare cardiac patients' ratings of their everyday cognitive functioning against significant others' ratings and selected neuropsychological tests. Sixty-nine patients completed a battery of standardised cognitive tests. Patients and significant others also completed the Everyday Function Questionnaire independently of each other. Patient and significant other ratings of patients' everyday cognitive difficulties were found to be similar. Despite the similarities in ratings of difficulties, some everyday cognitive tasks were attributed to different processes. Patients' and significant others' ratings were most closely associated with the neuropsychological test of visual memory. Tests of the patients' verbal memory and fluency were only related to significant others' ratings. Test scores of attention and planning were largely unrelated to ratings by either patients or their significant others.
Subject(s)
Cognition Disorders/etiology , Cognition Disorders/psychology , Heart Diseases/complications , Heart Diseases/psychology , Self-Assessment , Spouses/psychology , Attention , Cognition , Executive Function , Female , Humans , Male , Memory , Middle Aged , Neuropsychological Tests , Speech , Speech Perception , Surveys and Questionnaires , Visual PerceptionABSTRACT
BACKGROUND: Earlier studies show that medical factors and disease severity predict early readmission to hospital after coronary artery bypass graft surgery (CABGS). Few studies have investigated psychosocial predictors. This study investigated medical, sociodemographic and psychosocial predictors of 30-day hospital readmission. METHODS: A consecutive sample of 181 patients wait-listed for CABGS completed self-report questionnaires before surgery, and at 2 and 6 months after surgery. RESULTS: Twenty-six (14.4%) patients were readmitted within 30 days of hospital discharge. Readmitted patients were older (t=2.12, df=179, P=0.035), and more likely to be unmarried (chi=5.80, df=1, P=0.016), live alone (chi=8.33, df=1, P=0.004), have a history of hypertension (chi=2.731, df=1, P=0.098) and have higher anxiety before surgery (t=1.67, df=175, P=0.097). When these variables were entered into a backward stepwise logistic regression, the only significant unique predictor of 30-day readmission was living alone (Wald=7.08, odds ratio=3.42, P=0.008). Patients living alone were over three times more likely than those living with others to be readmitted to hospital. Disease severity and other medical factors were not associated with readmission. CONCLUSION: Living alone was identified as the single most important risk factor for early readmission after CABGS. Patients who live alone may benefit from additional support during early convalescence. Intervention studies could explore support options for these patients.
Subject(s)
Coronary Artery Bypass , Coronary Artery Disease/surgery , Patient Readmission , Single Person , Adaptation, Psychological , Adult , Aged , Aged, 80 and over , Coronary Artery Bypass/psychology , Coronary Artery Disease/psychology , Female , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Risk Assessment , Risk Factors , Single Person/psychology , Social Support , Surveys and Questionnaires , Time Factors , Treatment OutcomeABSTRACT
Candidates for coronary artery bypass graft surgery have been found to exhibit reduced cognitive function prior to surgery. However, little is known regarding the factors that are associated with pre-bypass cognitive function. A battery of neuropsychological tests was administered to a group of patients listed for bypass surgery (n = 109). Medical, sociodemographic and emotional predictors of cognitive function were investigated using structural equation modeling. Medical factors, namely history of hypertension and low ejection fraction, significantly predicted reduced cognitive function, as did several sociodemographic characteristics, namely older age, less education, non-English speaking background, manual occupation, and male gender. One emotional variable, confusion and bewilderment, was also a significant predictor whereas anxiety and depression were not. When significant predictors from the three sets of variables were included in a combined model, three of the five sociodemographic characteristics, namely age, non-English speaking background and occupation, and the two medical factors remained significant. Apart from sociodemographic characteristics, medical factors such as a history of hypertension and low ejection fraction significantly predicted reduced cognitive function in bypass candidates prior to surgery.
Subject(s)
Cognition Disorders/etiology , Cognition , Coronary Artery Bypass/adverse effects , Aged , Coronary Artery Disease , Demography , Emotions , Female , Health Status , Humans , Male , Middle Aged , Neuropsychological Tests , Postoperative Complications , Predictive Value of Tests , Retrospective Studies , Risk Factors , Verbal LearningABSTRACT
BACKGROUND: Many studies have demonstrated that health related quality of life (HRQoL) improves, on average, after coronary artery bypass graft surgery (CABGS). However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS. METHODS: 182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36), Profile of Mood States (POMS) and the Everyday Functioning Questionnaire (EFQ). These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL. RESULTS: For both the physical component summary scale (PCS) and the mental component summary scale (MCS) of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified (improvers and non-improvers). A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non-improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class; for the MCS the most significant predictors of non-improver membership were higher scores on POMS depression-dejection and manual occupation. CONCLUSION: It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of each patient, and those post-operative symptoms that could be possible targets for intervention to improve HRQoL outcomes.
Subject(s)
Coronary Artery Bypass , Coronary Disease/surgery , Outcome Assessment, Health Care/statistics & numerical data , Quality of Life , Risk Assessment/statistics & numerical data , Activities of Daily Living , Aged , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/psychology , Female , Hospitals, Urban , Humans , Logistic Models , Male , Middle Aged , Outcome Assessment, Health Care/methods , Prognosis , Psychometrics/instrumentation , Risk Assessment/methods , Risk Factors , Surveys and Questionnaires , VictoriaABSTRACT
BACKGROUND: While many studies have investigated cognitive impairments in patients after coronary artery bypass graft surgery, very few have closely evaluated presurgical cognitive functioning of bypass candidates. METHODS: A battery of neuropsychologic tests was administered to a consecutive series of patients listed for bypass surgery (n = 109). Cognitive function of bypass candidates was compared with that of a healthy control group (n = 25) and published test norms. RESULTS: Cognitive test scores in candidates for bypass were significantly lower than those of the control group on tests of attention, information processing speed, and verbal memory. Additionally, bypass candidates' cognitive test scores were significantly reduced compared with expected values derived from validated test norms, on all but one cognitive test. CONCLUSIONS: Cognitive performances of candidates for bypass were significantly lower than those of a healthy control group and published cognitive test norms.
Subject(s)
Cognition Disorders/epidemiology , Cognition , Coronary Artery Bypass , Coronary Disease/psychology , Preoperative Care , Aged , Attention , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Comorbidity , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/psychology , Coronary Artery Bypass, Off-Pump , Coronary Disease/surgery , Elective Surgical Procedures , Emotions , Female , Humans , Male , Mental Processes , Middle Aged , Neuropsychological Tests , Randomized Controlled Trials as Topic , Reference Values , Stress, Psychological/psychology , Verbal LearningABSTRACT
BACKGROUND: Cognitive difficulties have been reported after coronary artery bypass graft surgery using cardiopulmonary bypass. However, the cognitive benefit of off-pump surgery remains unclear. METHODS: Consecutively listed candidates for elective bypass were randomly assigned to either off-pump or on-pump techniques (n = 107). A battery of 11 standardized neuropsychological tests was administered before surgery, and again at 2 and 6 months after surgery. The two groups were compared using a range of statistical procedures, including growth modeling. RESULTS: There were no significant differences in cognitive test scores between the off-pump and on-pump groups using t tests at any of the time points. There were no differences between off-pump and on-pump groups in the incidence of cognitive deficits at 2 months or 6 months, with the exception that fewer off-pump patients showed impairment on one test of verbal fluency at 6 months. When the pattern of cognitive change over time between the two groups was compared using sophisticated modeling techniques, the two groups were again comparable, except for results on the test of verbal fluency, in which the off-pump group showed more rapid postsurgical cognitive gains than the on-pump group. CONCLUSIONS: The off-pump group appears to be generally comparable to the on-pump group in terms of short-term and long-term postsurgical neurocognitive outcomes.
