Women Worse After Heart Bypass Surgery

Nov. 24, 2003 -- Women are often sicker than men going into heart bypass surgery -- and their quality of life is often worse afterward.

A woman's emotional state, ability to function in daily life, even her thought processes are significantly worse than men who have had the same surgery, writes Barbara Phillips Bute, PhD, a researcher in anesthesiology, psychiatry, behavioral sciences, and surgery at Duke University Medical Center in Durham, N.C.

Her report appears in the latest issue of the journal Psychosomatic Medicine.

In it, Bute addresses quality-of-life issues surrounding women who have heart bypass surgery. Women who undergo bypass surgery tend to be older, less educated, hypertensive, diabetic, and obese, she writes. They also are more likely to be single, unemployed, and living alone -- as well as depressed and anxious -- than men who have the surgery.

While the goal of heart bypass surgery is to improve quality of life -- including physical functioning, social functioning, and psychological well-being -- not everyone reaps these benefits, writes Bute.

Other studies have found that women are more likely to die after the surgery, they stay longer in intensive care units, and they continue to have more heart problems. In fact, studies have indicated that women appear to do worse because they come into the hospital in worse condition than men.

Women More Anxious, Depressed

Bute's study sheds more light on this pattern, following 280 men and women for one year after their heart bypass surgery. Before surgery, each completed several questionnaires to assess their quality of life.

Each patient was about 60 years old. Each was asked about his or her ability to take care of themselves: personal care, walk, do household tasks, drive a car, fix their own meals. They were also asked about work activities, social interaction, anxiety, social support, and heart-related symptoms.

One year later, each took the same set of questionnaires -- which showed that, as a whole, all had improved. Depression and anxiety levels were significantly lower, they perceived their health to be better, they could do more work, and they were better able to get around and take care of themselves.

However, women did not have the same degree of improvement as men did, Bute writes. "Women are at greater risk for [thinking] difficulties, increased anxiety, decreased ability to perform tasks for daily living, diminished work-related activities, and reduced exercise capacity."

Quality of life -- not just survival -- is an issue that should be addressed when discussing heart bypass surgery and is suggested by the American College of Cardiology and the American Heart Association, she says. She also adds that quality of life at baseline was the strongest predictor of quality of life one year after surgery.

"It is generally assumed that relief of physical symptoms, such as angina after surgery, should by itself lead to improvements in quality of life," Bute writes. "But it is clear that mental health status also significantly affects quality of life."

Even though depressive symptoms may not always worsen after heart bypass surgery, depression greatly increases a woman's risk of having more heart problems.

SOURCE: Bute, B. Psychosomatic Medicine, vol 65.