DISABILITY-FREE SURVIVAL AFTER MAJOR CARDIAC SURGERY: A POPULATION-BASED COHORT STUDY
CCC ePoster Library. Sun L. 10/26/19; 280545; 310
Dr. Louise Sun
Dr. Louise Sun
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Abstract
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BACKGROUND: To date, much of the cardiovascular research has been dedicated to 'tombstone' outcomes such as death and adverse cardiovascular events, and little attention has been paid to outcomes that may also be important from a patient's perspective. We have previously derived disability-free survival as a novel, patient-defined outcome through a large-scale survey of patients living with cardiovascular diseases. Our current objective is to examine the rates of disability-free survival after coronary artery bypass grafting (CABG), valve, and combined CABG/valve surgeries in a real world cohort.

METHODS AND RESULTS: We conducted a retrospective cohort study of Ontario residents 40 years of age or older, who underwent CABG, and/or aortic, mitral or tricuspid valve surgery between October 1 2008 and December 31 2016, using CorHealth Ontario and ICES data. The primary outcome was disability-free survival, defined as the composite of stroke, ≥3 non-elective hospitalizations and long-term care admission within one year after surgery. To account for death as a competing risk, disability-free survival in each group was calculated using cumulative incidence functions (CIFs), and the risk of disability was assessed using a multivariable Fine and Gray subdistribution hazards model. A total of 72,824 patients were included in the study. The CIFs of disability-free survival are illustrated in the Figure. At one year, the cumulative incidence of disability were 2,431 (4.6%) after isolated CABG, 677 (6.5%) after single valve, 118 (9.0%) after multi-valve, 718 (9.0%) after CABG/single valve, and 87 (13.1%) after CABG/multi-valve surgery. After multivariable adjustment and with isolated CABG as the reference group, the HRs for disability at one-year were 1.34 (95% CI: 1.21-1.48) after single valve, 1.43 (1.18-1.75) after multi-valve, 1.38 (1.26-1.51) after CABG/single valve, and 1.78 (1.43-2.23) after CABG/multi-valve surgery.

CONCLUSION: We found that the cumulative incidence of disability was lowest after isolated CABG and highest after combined CABG and multiple valve reconstruction. The incidence of disability exceeds the reported rates of death in every procedure category. Our findings point to a need for further research and interventions to bring patients back to the center of the care they receive, through implementation of validated disability prediction tools to assist with the decision-making process.
BACKGROUND: To date, much of the cardiovascular research has been dedicated to 'tombstone' outcomes such as death and adverse cardiovascular events, and little attention has been paid to outcomes that may also be important from a patient's perspective. We have previously derived disability-free survival as a novel, patient-defined outcome through a large-scale survey of patients living with cardiovascular diseases. Our current objective is to examine the rates of disability-free survival after coronary artery bypass grafting (CABG), valve, and combined CABG/valve surgeries in a real world cohort.

METHODS AND RESULTS: We conducted a retrospective cohort study of Ontario residents 40 years of age or older, who underwent CABG, and/or aortic, mitral or tricuspid valve surgery between October 1 2008 and December 31 2016, using CorHealth Ontario and ICES data. The primary outcome was disability-free survival, defined as the composite of stroke, ≥3 non-elective hospitalizations and long-term care admission within one year after surgery. To account for death as a competing risk, disability-free survival in each group was calculated using cumulative incidence functions (CIFs), and the risk of disability was assessed using a multivariable Fine and Gray subdistribution hazards model. A total of 72,824 patients were included in the study. The CIFs of disability-free survival are illustrated in the Figure. At one year, the cumulative incidence of disability were 2,431 (4.6%) after isolated CABG, 677 (6.5%) after single valve, 118 (9.0%) after multi-valve, 718 (9.0%) after CABG/single valve, and 87 (13.1%) after CABG/multi-valve surgery. After multivariable adjustment and with isolated CABG as the reference group, the HRs for disability at one-year were 1.34 (95% CI: 1.21-1.48) after single valve, 1.43 (1.18-1.75) after multi-valve, 1.38 (1.26-1.51) after CABG/single valve, and 1.78 (1.43-2.23) after CABG/multi-valve surgery.

CONCLUSION: We found that the cumulative incidence of disability was lowest after isolated CABG and highest after combined CABG and multiple valve reconstruction. The incidence of disability exceeds the reported rates of death in every procedure category. Our findings point to a need for further research and interventions to bring patients back to the center of the care they receive, through implementation of validated disability prediction tools to assist with the decision-making process.
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