Association of Gender, Mental Status and Marriage on Health Related Quality of Life Following Cardiac Surgery

Introduction: In this report, we explore the association between marital status, gender and patient acuity on 1 year changes in health related quality of life (HRQL) following cardiac surgery.

Methods: Subjects (n=134) are part of an ongoing cohort study to assess HRQL following a cardiovascular surgical intervention between September 2005 through January 2006. HRQL was assessed using the SF-12 Composite Mental (CMS) and Physical (CPS) Scores. HRQL was assessed at baseline, 6 and 12 mths.

Results: Subjects were primarily male (73%), aged 64 years, and presented mainly for a coronary artery bypass (75%). Marital status and gender were significant (p<0.002) predictors of CMS at baseline. CMS was significantly improved at 12 mths (p<0.001) with a significant time by gender effect (p<0.010). No time by marital status effect was observed. Married patients experienced a 3% (48.9 vs. 51.5) increase in CMS at 12 months compared to a 2% decrease for non-married pts (49.2 vs. 47.7). CMS for both men (53.1, 53.7, 51.4) and women (45.0, 53.2, 47.7) pts increased from baseline to 6 months only but men at 12 months regressed below baseline. Both married (54.5, 54.9, 52.5) and unmarried (51.8, 52.5, 50.3) men demonstrated little change in CMS. However, both married (43.3, 53.4, 50.5) and unmarried women (46.7, 52.9, 45.0) dramatically improved at 6 months and equally regressed at 12 months. Although no marital status by acuity interaction was observed, it is worth noting that the only least severe, non-married pts scored regressed directly from baseline to 12 mths (52.0, 50.2, 42.6). All patients significantly improved CPS scores from baseline to 12 months (p<0.001). At baseline, no significant differences in CPS were observed for marital status, gender, or pt acuity. Both married (44.4, 47.7, 48.5) and unmarried pts (45.7, 49.3, 49.6) improved CPS directly from baseline. Among married pts, women (40.8, 46.8, 46.5) made the greatest gains from baseline to 6 months but men (47.9, 46.6, 50.4) improved steadily through 12 months.

Conclusion: Following cardiac surgery, physical HRQL steadily improved throughout follow-up whereas mental HRQL peaked at 6 mths. These results suggest that cardiac surgery removes the physical burden of cardiac disease but provides only limited mental status benefits especially for women. This finding needs further exploration to understand the limited improvement in mental status in women which has implications for policy makers involved with providing research funding to understand the differences in treatment interventions for men and women.