**4. Self rated health**

perioperative characteristics were assessed. Psychological self-report questionnaires were completed preoperatively and 6, 12, 24, 36, and 48 months after discharge. Clinical endpoints were mortality and cardiac events requiring hospitalization during follow-

An anxiety symptoms scale was constructed out of five items from the Cornell Medical Index, which was administered to the cohort at baseline. During 32 years of follow-up incidence of

CHD was observed.

17,885 Patients who underwent a primary CABG

119 Consecutive patients awaiting elective CABG, completed a battery of psychosocial measures in a three-stage repeated-measures design. Relevant medical data were also extracted from patients' medical records 6 months postoperatively to allow for the examination of potential covariates.

surgery were identified. Independent variables included age, gender, race, median household income based on patient's ZIP code, primary expected payer, the Deyo, Cherkin, and Ciol Comorbidity Index, and an anxiety comorbidity diagnosis. Outcome variables included in-hospital length of stay and patient disposition (routine and nonroutine discharge).

STAI-T (score OR: 1.07; 95% CI: 1.01-1.15; p = 0.05) were independently associated with mortality. The occurrence of cardiovascular hospitalization was independently associated with postoperative intensive care unit days (OR: 1.41; 95% CI: 1.01-1.96; p =0.045) and post discharge 6th month STAI-T (OR: 1.06; 95% CI:1.01-1.13; p = .03).

Compared with men reporting no symptoms of anxiety, men reporting two or more anxiety symptoms had elevated risks of fatal CHD (age-adjusted odds ratio [OR] = 3.20, 95% confidence interval [CI]: 1.27 to 8.09), and sudden death (ageadjusted OR = 5.73, 95% CI: 1.26 to 26.1). The multivariate OR after adjusting for a range of potential confounding variables was 1.94 (95% CI: 0.70-5.41) for fatal CHD and 4.46 (95% CI: 0.92-21.6) for sudden death. No excess risks were found for nonfatal myocardial infarction or

27% of rural patients had a comorbid anxiety diagnosis. Rural patients who had nonroutine discharge were more likely to have comorbid anxiety diagnosis compared to rural patients who had a routine discharge. There was a significant interaction effect between having an anxiety diagnosis and gender on length of hospital stay but not for patient

Increased postoperative anxiety and increased preoperative depression, were identified as risk factors for cardiacrelated readmission independent of the only significant covariate identified, cardiopulmonary bypass time.

angina.

disposition.

up.

402 cases of incident coronary heart disease

Kawachi I. Symptoms of anxiety and risk of coronary heart disease. The Normative

Aging Study.

472 Artery Bypass

Dao TK. Gender as a moderator between having an anxiety disorder diagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients.

Oxlad M. Psychological risk factors for cardiac-related hospital readmission within 6 months of coronary artery bypass graft surgery.

**Table 2.** Some important studies about anxiety and CABG

Self-rated health (SRH) is measured with a simple question "How do you rate your health in general?" There are five possible responses: very good, good, fair, poor and very poor [31]. Self rated health has been shown to be a potent predictor of mortality and morbidity, functional decline, disability and utilization of health care even after controlling for several sociodemo‐ graphic and health indicators The association can be explained by three ways: (1) SRH is a more comprehensive and sensitive measure of health status than the other psychosocial covariates in the analyses; (2) SRH measures individual optimistic or pessimistic disposition, that as such, may be associated with survival; or (3) SRH also measures characteristics other than health status itself, such as family history, health behaviour, and social and psychological resources [32]. In a review SRH was described as an active cognitive process that is independ‐ ent from formal definitions of health. Self rated health covers bodily sensations that are directly available only to the individuals. These sensations may reflect important physiological dysregulations, such as inflammatory processes. SRH is an individual and subjective concep‐ tion that is related to death, and builds a connection from the social world and psychological to the biological world. Therefore the answer to the SRH question may summarize the dimensions of health that are most important and determinant to each individual [33]. SRH has been described as one of the most important health outcomes available and recommended as a tool for disease risk screening, as an outcome indicator in the primary care, and standard part of clinical trials [34]. Several studies in different field confirmed the importance of SRH, one of them described that good self health 3 months after PCI predicted good clinical outcome after 4 years [35]. SRH was reported as an independent predictor of long term mortality in older women after myocardial infarction. Patients dissatisfied with their general health status were at more than six times higher risk of mortality than the satisfied ones [36]. There are only few data available on the link between CABG and SRH. Oxlad et al. investigated consecutive elective CABG patients on self-report measures including optimism, illness representations, self-rated health, social support, coping methods, depression, anxiety and post-traumatic stress disorder. Poor pre-operative psychological functioning was the strongest psychological risk factor for adverse psychological functioning six months post-operatively [37].

ness is a determinant of quality of life in patients with chronic disease. Illness intrusiveness covers the disease- and treatment-induced disruptions to lifestyles, activities, and interests [43]. There is only one available study about the relationship of illness intrusiveness and CABG: our work group investigated psychosocial factors like illness intrusiveness, depression, anxiety, sleeping disorders and found an independent association with the occurrence of major adverse cardiac and cerebrovascular events (MACCE) after adjustment of biomedical factors and perioperative variables following cardiac surgery. Additionally, severity of illness intrusiveness, sleeping problems and social inhibition increased in the MACCE positive patients during the three-year period; these tendencies were not observed in the event-free

Short and Long Term Effects of Psychosocial Factors on the Outcome of Coronary Artery Bypass Surgery

http://dx.doi.org/10.5772/54622

475

With aging of the population and sophisticated health care technologies the number of patients with chronic diseases has extremely increased. As a result, improving the daily functioning and quality of life of the chronically ill has become an important goal of medical and surgical interventions. Therefore assessing the quality of life has been brought into the limelight [45]. On the other hand, predictive value of quality of life on survival and other outcomes of cardiac surgery has been also studied. In a prospective study of 6305 patients who underwent isolated coronary artery bypass the overall functional health-related quality of life improved after recovery from cardiac surgery. Reduced long-term survival following cardiac surgery even after adjustment for known risk factors associated with survival after cardiac surgery was associated with lower functional health related quality of life beyond the posthospital recovery phase. The degree of functional recovery was directly related to subsequent survival [46]. In a prospective cohort study the preoperative quality of life was an independent predictor of 6 month mortality following CABG even after adjusting for traditional risk factors. The magni‐ tude of the effect (39% increase in risk for a small difference in quality of life score) was clinically

The increased operative mortality and morbidity of women compared with men undergoing CABG surgery results from differences in methodology, low number of women in studies reporting negative findings, many studies, both positive and negative, did not take into account preoperative differences in health status between the sexes. Women more frequently have factors associated with increased short- and long-term mortality, such as less common use of internal mammary artery grafts. According to the reported analyses, they are older, less educated, have more severe angina and congestive heart failure, lower functional status, and higher level of depressive symptoms. At time of referral, women are at more advanced disease stage than men; however, despite being more symptomatic, women have less extensive coronary artery disease than men as determined by coronary angiography results [48]. This

important, and it is a non-invasive, easily available tool for clinicians [47].

group [44].

**7. Quality of life**

**8. Gender differences**
