Gender and Recovery from Coronary Artery Bypass Surgery (eBook)

A Psychological Perspective

Friederike Kendel (Autor)

eBook Download: PDF

2009 | 2009
VIII, 104 Seiten
Steinkopff (Verlag)
978-3-7985-1856-8 (ISBN)

Infos

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

Hypotheses.- Method.- Results.- Discussion.- Summary.- Zusammenfassung.- References.

Textauszug

5 DISCUSSION (S. 62-63)

There are three key results that will be discussed. First, in section 4.1, depression emerged as the most important psychosocial risk factor for both mortality and physical functioning in the entire sample, while education mediated the relationship between gender and mortality. The predictive priority of depression over physical functioning was confirmed in a cross-lagged panel design, in which cross-sectional associations and baseline scores were controlled for.

Second, section 4.2 showed comparable improvement for both men and women after surgery concerning the mean scores of physical functioning and depression. Third, strain through housework in the early phase of recovery proved to be associated negatively with physical functioning and positively with depression in both men and women. These three results will now be discussed with regard to the baseline health status. In addition, methodological considerations, limitations of the study and clinical implications will be outlined.

5.1 Gender Differences in Outcome

In the present study, the all-cause mortality rate of women after CABG surgery appeared to be twice that of men. For the analysis, a time period of 1 year after surgery had been selected. The majority of studies (e.g. Vaccarino et al., 2002, Regitz-Zagrosek et al., 2004) also found gender differences in early mortality, which is defined as mortality within 28 days after surgery. Only a few studies went beyond this short term. If a survival time of over 1 year was considered, either no gender differences were found or female gender was even shown to be a predictor for an improved survival rate (Brandrup-Wognsen et al., 1996, Toumpoulis et al., 2006).

In contrast, the gender ratio of the present analysis with regard to the survival rate equalled that of the results for early mortality. Previous studies in search of an explanation of these gender differences have yielded quite diverse results. In some studies, after adjustment for clinical risk factors, the gender differences in early mortality disappeared (Abramov et al., 2000, Toumpoulis et al., 2006). In other studies (e.g. Regitz-Zagrosek et al., 2004, Vaccarino et al., 2002), the gender gap remained visible. Most of these studies, however, were only retrospective, which implies that psychosocial risk factors could not enter adequately into the analysis.

In contrast to these earlier studies, the present study was designed as prospective, thus allowing a rich variety of socioeconomic, clinical and psychosocial risk factors to be included. By this construction, the relative importance of psychosocial factors in comparison with the classical clinical risk factors, which have been more closely examined in earlier analyses, could be demonstrated. Two main groups of hypotheses were tested to explain the gender difference in mortality after CABG. The first group examined the moderator status of gender, while the second concerned the mediator status of risk factors.

The first group refers to the fact that risk factors have a stronger impact on wellbeing in women than in men, which is usually indicated by interactions. The second type of hypothesis alludes to the fact that some risk factors appear predominantly in women. If these risk factors are, in turn, similarly related to mortality in men and in women, they can explain the gender difference in mortality and physical functioning. Three different types of potential mediator or moderator variables – clinical risk factors, sociodemographic variables and psychosocial variables – provide the framework for the following presentation.

Produkt-Details

• Erscheint lt. Verlag: 24.1.2009
• Reihe/Serie: Fortschritte in der Herz-, Thorax- und Gefäßchirurgie
• Reihe/Serie: Fortschritte in der Herz-, Thorax- und Gefäßchirurgie
• Zusatzinfo: VIII, 104 p. 11 illus., 8 illus. in color.
• Verlagsort: Heidelberg
• Sprache: englisch
• Themenwelt: Geisteswissenschaften
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Psychiatrie / Psychotherapie
• Schlagworte: Bypass • Bypass Surgery • Cardiovascular • coronary artery • Gender • gender and recovery
• ISBN-10: 3-7985-1856-4 / 3798518564
• ISBN-13: 978-3-7985-1856-8 / 9783798518568