CLINICAL STUDY: GENDER AND CARDIAC DISEASE
Gender differences in recovery after coronary artery bypass surgery
Viola Vaccarino, MD, PhD* ,*,
Zhen Qiu Lin, PhD ,
Stanislav V. Kasl, PhD ,
Jennifer A. Mattera, MPH,
Sarah A. Roumanis, RN,
Jerome L. Abramson, PhD* and
Harlan M. Krumholz, MD, FACC||
* Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
|| Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Manuscript received July 3, 2002;
revised manuscript received September 30, 2002,
accepted October 10, 2002.
* Reprint requests and correspondence: Dr. Viola Vaccarino, Emory University School of Medicine, Department of Medicine, Division of Cardiology, 1256 Briarcliff Road, Suite 1 North, Atlanta, Georgia 30306, USA.
lvaccar{at}emory.edu
OBJECTIVES: This study was designed to examine whether female gender is associated with poorer recovery after coronary artery bypass graft (CABG) surgery.
BACKGROUND: The risks and benefits associated with CABG surgery in women are not as well established as they are in men, and there are concerns that women may have worse outcomes. The recovery period after CABG (the first four to eight weeks after the surgery) is a vulnerable time, with higher risks of complications and hospital readmission. There is little information on patients’ experiences during this phase, particularly among women.
METHODS: We prospectively followed 1,113 patients (804 men and 309 women) who underwent first CABG consecutively between February 1999 and February 2001. Patients were interviewed at baseline and between six and eight weeks after surgery. Clinical data were abstracted from medical records.
RESULTS: Compared with men, women were older and more often had unstable angina and congestive heart failure, lower physical function (PF), and more depressive symptoms in the month before surgery. At six to eight weeks after CABG surgery, after adjustment for baseline characteristics, the rate of hospital readmission was 20.5% in women and 11.0% in men (p = 0.005), and the mean number of physical symptoms and side effects was 2.5 in women and 2 in men (p = 0.0009). Whereas, on average, PF remained unchanged in men (an increase in score of 0.3 points, 95% confidence interval [CI], –1.1 to 1.8) and depressive symptoms improved (a decrease of 0.2 depressive symptoms, 95% CI, –0.4 to –0.04), women showed, on average, a 13-point decline in physical function (95% CI, –15.8 to –10.4) and an increase of 0.5 in depressive symptoms (95% CI, 0.1 to 0.9).
CONCLUSIONS: After CABG surgery, women have a more difficult recovery compared with men, which is not explained by illness severity, presurgery health status, or other patient characteristics.
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Abbreviations and Acronyms
| | CABG | | coronary artery bypass graft | | CI | | confidence interval | | GDS | | Geriatric Depression Scale | | LVEF | | left ventricular ejection fraction | | PF | | physical function | | SF-36 | | Short Form 36-item Health Survey |
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