LAUSR

Background For advanced coronary disease, coronary artery bypass graft (CABG) surgery generally improves patients' symptoms and long‐term survival. Unfortunately, some patients experience worse health‐related quality of life (HRQL) after CABG. The objective of this study is to report the frequency and risk factors associated with 1‐year post‐CABG HRQL deterioration. Methods From 2002 to 2007, 2203 “Randomized On/Off Bypass” (ROOBY) trial patients randomly received either off‐pump or on‐pump CABG at 18 VA medical centers. Subjects completed both baseline and 1‐year Seattle Angina Questionnaire (SAQ) and the Veterans Rand 36 (VR‐36) questionnaires to assess HRQL. Using previously published criteria, the rates of clinically significant changes were determined for the SAQ [angina frequency (AF), physical limitation (PL), and quality of life (QoL)] and VR36 [mental component score (MCS) and physical component score (PCS)] subscales. Multivariate regression models were then used to identify pre‐CABG patient characteristics associated with worsened 1‐year HRQL status for each subscale. Results Over 80% of patients had an improvement or no change in SAQ and VR‐36 subscale scores 1 year after CABG. The HRQL scale‐specific deterioration rates were 4.5% SAQ‐AF, 16.8% SAQ‐PL, 4.9% SAQ‐QoL, 19.4% VR36‐MCS, and 13.5% VR36‐PCS. Predictors of 1‐year HRQL deterioration were diabetes and smoking for the SAQ‐AF; diabetes, chronic obstructive pulmonary disease (COPD), and peripheral vascular disease (PVD) for SAQ‐PL; COPD and depression for the SAQ‐QoL; diabetes for VR36‐PCS, and history of stroke and depression for VR36‐MCS. The baseline score was an independent predictor for worsening in all the subscales studied. Conclusions Among VA patients, less than 20% experienced worse HRQL 1 year after CABG. For patients with low symptom burden at baseline, diabetes, smoking, depression, PVD, COPD, and a prior stroke, clinicians should be more cautious in pre‐CABG counseling as to their anticipated HRQL improvements.