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ARTICLE

Age does not limit quality of life improvement in cardiac valve surgery

Artyom Sedrakyan, MD^*, Viola Vaccarino, MD, PhD, A. David Paltiel, PhD^*, John A. Elefteriades, MD, FACC, Jennifer A. Mattera, MPH, Sarah A. Roumanis, RN, Zhenqiu Lin, PhD and Harlan M. Krumholz, MD, FACC^*||,*

^* Division of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
Department of Medicine, Division of Cardiology, Emory University School of Medicine, and Rollins School of Public Health, Atlanta, Georgia, USA
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
^|| Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

Manuscript received December 31, 2002; revised manuscript received March 12, 2003, accepted April 10, 2003.

^* Reprint requests and correspondence: Dr. Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar Street, P. O. Box 208025, New Haven, Connecticut 06520-8025, USA.
harlan.krumholz{at}yale.edu

OBJECTIVES: We sought to determine the association of age with the change in quality of life (QOL) after valve surgery.

BACKGROUND: Improvement in QOL is one of the principal goals of valve surgery. These procedures are being done with increasing frequency for older patients.

METHODS: We prospectively studied 148 patients with aortic valve procedures and 72 patients with mitral valve procedures. Patients' QOL was measured at baseline and at 18 months using the Medical Outcomes Trust Short Form 36-Item (SF-36) Health Survey (response rate 90%). The association of age with change in QOL was measured by multiple regression analysis and based on two meta-scores of the SF-36: the Mental Component Summary (MCS) and the Physical Component Summary (PCS).

RESULTS: Overall improvement in most domains of the SF-36, including the MCS and the PCS scores, was substantial. Improvement in the MCS score was not influenced by age in either aortic (0.09 score point improvement per 10-year age increments; p = 0.9) or mitral (0.90 score point improvement per 10-year age increments; p = 0.3) patients. Similarly, improvement in the PCS score did not vary by age in aortic patients (–1.00 score points per 10-year age increments; p = 0.2) and only slightly varied by age in mitral patients (–1.90 score points per 10-year age increments, p = 0.02). In the latter, despite statistical significance, the association was not substantial or clinically important.

CONCLUSIONS: Among patients referred for cardiac valve surgery, age does not appear to limit the QOL benefits of surgery.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   MCS = Mental Component Summary   NYHA = New York Heart Association   PCS = Physical Component Summary   PVD = peripheral vascular disease   QOL = quality of life   SD = standard deviation   SF-36 = Medical Outcomes Trust Short Form 36-Item Health Survey

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