HEALTH RELATED QUALITY OF LIFE OF PATIENTS UNDERWENT OPEN HEART SURGERY

Rani S 1 , Dr. Ram Sankar P 2 , Kavitha N 3 , Subhashini S 3 , Ramya R 3 , Sasikala K 3 , Divya S 3 and Suganthi S 3 . 1. Clinical Instructor, College of Nursing, JIPMER, Puducherry. 2. Assistant Professor, Dept of CTVS, JIPMER, Puducherry. 3. PBDN students, College of Nursing, JIPMER, Puducherry. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Introduction:-
Cardio vascular diseases remain as the leading cause of mortality worldwide in both men and women 1 . But the advancing medical technologies in cardiac surgery have resulted in increasingly longer life spans, and of these CABG, valvular surgery and intra cardiac repair is the widely used and well accepted therapy for patients with significant cardio vascular problems. Health related quality of life (HRQOL) is an increasingly important aspect in assessing the outcome of any medical intervention 2 as well in the management and care of patients after cardiac surgery, while the main treatment aim is not to reduce mortality rates, but also to improve the quality of life. Health related quality of life in nature is multifaceted, based on the subjective perception of patient's health, and includes not only physical but also psychological and social functioning. Several authors have referred to the WHO's definition of health as a basis for HRQoL namely as a "state of complete physical, mental or social wellbeing" and merely the absence of disease or infirmity. HRQOL then results the impact of disease and medical / surgical interventions on patient function, as reported by the patient. HRQOL is a perceived physical and mental health in domains related to physical functioning, role functioning, social functioning, general health and fatigue and emotional wellbeing, focuses on the impact of health status on quality of life. The past two decades have seen the development of multiple health status measurement tools to assess the health related quality of life. While, these tools vary in the constructs they measure, all have the common goal of capturing "health status as perceived by the patients in areas of health identified to be of value to the patient", most common being physical functioning, psychological functioning, role functioning and general health perception. Quality of life (QOL) outcomes have become a major focus among open heart surgeries such as coronary artery bypass grafting (CABG), valvular replacement and cardiac defects repair, a common and effective treatment for cardiac diseases: 1. Typically conceptualized in terms of the patient's subjective experience, 2. QOL is multifaceted, 3. Comprising self-assessments in several areas of functioning 4. Patients underwent cardiac surgeries report problems in a number of domains, including physical activity, social interaction and emotion, 5. Although most experience improved QOL following CABG (6 -8).
With an increasing number of elderly patients being referred for cardiac surgery, it is important to assess outcome in terms of quality of life alongside the more traditional measures of survival and morbidity.
Generic HRQOL instruments like SF-36 are those without disease specific questions and can therefore be applied and compared across population of patients. These instruments therefore measure overall health status, including any impact from cardiac or non-cardiac variables. Open heart surgery mainly focuses on the biologic and physiologic outcome and do not capture the impact of intervention on patients health related quality of life. Thus there is limited literature evaluating health related quality of life before and after open heart surgery. According to WHO 2010 it is estimated that more than 800,000 open heart surgeries are performed worldwide every year. Open heart surgery is the most common type of open heart surgeries in the United States, with more than 500,000 surgeries performed each year. In India, approximately 50,000 open heart surgeries are performed annually. Recently, however, the emphasis has been more toward assessing outcome in terms of patients' perceptions of changes in their state of health over time and how this affects their lives; in other words, assessing the health-related quality of life 3. HRQOL encompasses a holistic approach to medicine by including not only the patient's physical status, but mental, emotional, and social status, there is a need to evaluate the patient's perception of the stressfulness surrounding the surgical procedure and to understand the possible effects of this perception on recovery and in different aspects of quality of life after open heart surgery. In the light of the above the researcher found it is desirable to assess quality of life and lifestyle before and after the open heart surgery 4 .

Materials and Methods:-
The study was a descriptive study with cross-sectional survey design conducted in Cardio Thoracic

Data Collection Procedure:-
The institutional ethical clearance was taken before the data collection. Informed consent was taken from the participants after explaining the study. By non-probability convenience sampling technique 180 Participants who fulfilled inclusion criteria were explained the purpose of study to the participants and written informed consent was obtained from the participants. Data was gathered using the standardized structured questionnaire on health related quality of life (Modified RAND SF-36) along with socio demographic profile with duration of 20 to 30 minutes for each participant by interview method.

Statistical analysis:-
Both descriptive and inferential statistics were used for analyzing the data. The baseline characteristics were presented as frequencies and percentages. To describe the association of level of Health related Quality of life (HRQol) with demographic and clinical parameters chi-square test was performed.

Conclusion:-
This study has showed that 45% of patients had fair level of health related quality of life after open heart surgery and also associated with demographic variables such as gender, type of work and duration after surgery. The findings of this study show the importance of need for early rehabilitation programs to be initiated with patients after open heart surgery.