Objectives: To determine the quality of life in octogenarians after open heart surgery.
Background: Despite an increasing number of cardiac operations on octogenarians, the outcome as measured by functional status, independence of living, and psychological parameters of quality of life remain unproved.
Methods: Two groups of octogenarians (group 1, undergoing operation in 1986; group 2 in 1991) were reviewed retrospectively to determine operative mortality and functional results.
Results: Group 1 (n= 15, mean age of 83.2 years) and group 2 (n=53, mean age 83.0 years) were studied. Operations included isolated coronary artery bypass grafting (group 1, 10; group 2, 29) and valve replacements [+ or-] coronary artery bypass grafting [+ or-] other procedures (group 1: 5; group 2, 24). Group 1 had 9% hospital mortality and 53% actuarial survival after a mean follow-up of 6.3 years. Group 2 had 17% hospital mortality and 72% actuarial survival after a mean follow-up of 1.5 years. At follow-up, significant improvements were observed in New York Heart Association (NYHA) angina class, congestive car-diac failure class, number of cardiovascular symptoms, and indices for satisfaction with overall life and general affect in both groups. Further, group 2 also showed significant improvements in independence of living, ease of life, and Karnofsky dependency category, but these improvements were less evident in group I after a longer period of follow-up. At follow-up, 75% of group I and 84% of group 2 octogenarians would definitely have made the same decision to undergo open heart surgery in retrospect.
Conclusion: This study demonstrates improved quality of life after open heart surger-y in octogenarians.
(CHEST 1995; 108:919-26)
NYHA=New York Heart Association
Key words: coronary artery bypass; octogenarian; quality of life
Quality of life should be an important aspect in assessing the outcome of any therapeutic intervention. Effectiveness of treatment for heart failure, hypertension, clinical trials for treatment of human immunodeficiency virus infection, heart transplantation, and coronary artery bypass grafting have been reported using quality of life as an end point assessment. Quality of fife becomes a pertinent issue at a time when the benefits from expensive medical and surgical interventions are being debated.
Projected changing population demographics in the mid to late 1990s and the early part of next century estimates that 43% of all Americans will reach the age of 80 years and live for an average of 8 more years in the ninth decade of their lives. The absolute number of octogenarians is increasing the most rapidly of all age groups. At present, octogenarians constitute 3% of the US population (7.4 million in early 1990s) arid this figure is set to rise to over 10 million in the next 10 years. The estimated prevalence of coronary disease in the octogenarians is approximately 20%. The age-adjusted mortality from cardiac causes will be more than offset by the increase in the absolute number of individuals beyond 80 years.
Increasing referrals of octogenarians with atherosclerotic coronary artery disease and valvular diseases for surgical intervention reflects this increasing patient population. At our institution, octogenarian patients...