Gender and Recovery from Coronary Artery Bypass Surgery

The number of coronary artery bypass graft (CABG) operations has increased continually over the past decade. To date, roughly one-third of these are performed on women. Despite the tremendous progress made in cardiovascular surgery, not all patients profit equally from it, and the mortality rate of women still exceeds that of men by a factor of two. Studies conducted to investigate this marked gender difference have yielded conflicting results. In particular, adjustment for clinical risk factors seemed to diminish the difference, but could not fully explain it.

Therefore psychosocial parameters, in particular depression and psychosocial stress, have gained increasing attention as predictors for both mortality and quality of life after CABG operation. Gender differences in these variables have long been observed in patients undergoing CABG: female patients are on average older, more often depressive and more often living alone than male patients. This book presents the very first German study to focus on these gender differences.

By describing the gender-specific influence of psychological and clinical variables on the recovery process, this work fills an important gap in cardiovascular research. Its approach is interdisciplinary in the best sense. The study underlines the importance of psychosocial variables for both mortality and quality of life in the context of CABG. Thus, it may be seen as a basis for a better understanding and treatment of CABG patients.

Zusammenfassung
Progress in coronary artery bypass graft surgery has irrefutably improved the quality of life of many patients. However, we are confronted with the finding that women - hibit a higher mortality rate than men. In part, this difference can be explained by clinical parameters such as age, disease severity, or comorbidity factors that have been well studied, but which do not fully explain the observed differences. This is one reason why, in recent years, psychosocial variables have attracted special atten- on in this context. In fact, women and men having undergone a bypass operation - ry a great deal with respect to, e. g. , depression, partner status, and socio-economic status. Moreover, psychological well-being, on the one hand, and social isolation, on the other hand, definitely influence the recovery process, particularly when consi- red under the gender aspect. The Deutsches Herzzentrum Berlin has been actively supporting gender-specific research for many years. In this context, a large prospective study on gender dif- rences in recovery after bypass surgery, carried out by the Competence Network of Heart Failure, was started at our Department for Cardiothoracic and Vascular Sur- ry. From the beginning of the study, psychosocial variables were included as being substantial contributors. The starting point of the study presented here* by psychologist Dr. Friederike Kendel are recent empirical investigations about gender differences in coronary heart disease and the course of recovery after bypass surgery.

Inhalt
Introduction: Gender Differences in Mortality After CABG.- Gender Aspects of Risk Factors.- Outcome Measures.- Hypotheses: Gender Differences in Risk Factors and Outcomes.- Moderator Hypotheses.- Mediator Hypotheses. Method: Participants.- Measurements.- General Statistical Procedures.- Sample.- Results: Predictors of Mortality and Physical Functioning Based on Preoperative Data.- Predictors of Well-Being Based on Longitudinal Data.- Predictive Relationship Between Physical Functioning and Depression.- Discussion: Gender Differences in Outcome.- Gender Aspects in Recovery.- Is Depression Predictive for Physical Functioning?- Limitations.- Clinical Implications.- Conclusion.- Summary.- References