Predictors of quality of life after cardiac procedures: a mixed-methods study.

PURPOSE: Cardiovascular disease has a major impact on patients' lives. Cardiac procedures aim to improve patient health-related quality of life (HRQoL); however, some patients show little to no improvement afterwards. Changes in HRQoL are used to evaluate quality of care, and to enhance shared decision-making. We aimed to explore determinants predictive of HRQoL changes in patients undergoing a cardiac procedure. METHODS: A stepwise, mixed-methods study was conducted. First, relevant determinants were identified and selected by performing a literature search and Delphi study. Next, a cross-sectional survey study was conducted among patients who underwent a cardiac procedure. The impact of determinants on changes in HRQoL (measured with the SF36-2/SF12-2, or Effect On Quality-Of-Life Questionnaire (AFEQT)) was examined. RESULTS: Based on the literature search and Delphi study, 19 determinants were selected and subsequently observed among patients. In total, 1016 patients participated; 731 undergoing a CABG, PCI or SAVR (CPS-group), and 285 undergoing a PVI (PVI-group). In the CPS-group, 9 determinants were associated with significant changes in physical HRQoL and 9 determinants for mental HRQoL were found. In the PVI-group, significant determinants in the four AFEQT domains were found. CONCLUSION: This study shows that several psychological and social factors are significant predictors for patients' HRQoL after cardiac procedures. Addressing these factors in consultations is considered important when deciding about cardiac procedures. This may allow shared decision making, enhance patient expectations and be beneficial for choosing the most optimal treatment choice for the individual patient.