Abstract 14574: Who is at Risk for Exhaustion Post-Cardiac Surgery
Background: Vital exhaustion (VE), a psychological state characterized by extreme fatigue, is an independent prognostic indicator of future cardiac events. Despite its prognostic value, little is known about predictors of VE after cardiac surgery.
Objective: To investigate socio-demographic and clinical factors associated with risk of postoperative VE following coronary artery bypass graft (CABG) surgery.
Methods: In a prospective, cross-sectional pilot study at two cardiac centers, 42 post-CABG patients (age 67.5 ± 12.6 years, 90.5% male) were screened for depression (Patient Health Questionnaire-2) and evaluated for VE (Maastricht Interview) 4 to 8 weeks post-hospitalization discharge. Potential covariates included socio-demographics, clinical characteristics, medical history, cardiovascular risk factors, medications, and preoperative hematology. Stepwise logistic regression analyses were performed to identify predictors of VE.
Results: Prevalence rate of VE was approximately 41% (n = 17). Older patients (> 65 years) were less likely to be exhausted (Table; p < 0.05). After adjusting for age, independent predictors of exhaustion were presence of right coronary artery disease (p < 0.05) and higher preoperative left ventricular ejection fraction (LVEF; p < 0.01). In a separate regression model controlling for age and LVEF, patients with increases in preoperative hemoglobin (OR 3.19, 95% CI 1.13 - 9.01, p = 0.03) and eosinophils (OR 1.02, 95% CI 1.00 - 1.04, p = 0.02) were more likely to be exhausted (Pseudo R2 = 0.62).
Conclusion: The association of VE following CABG with higher LVEF, presence of right coronary artery disease, and higher hemoglobin and eosinophil concentrations is novel, unexpected and clinically relevant. Identifying risk factors for VE may increase our ability to target patients in whom exhaustion may hamper surgical recovery. Further study is needed to investigate the effect of VE on short- and long-term postoperative outcomes.
- © 2011 by American Heart Association, Inc.