Research

Quality of life can both influence and be an outcome of general health perceptions after heart surgery

Lars Mathisen^1,2 , Marit H Andersen^1,3 , Marijke Veenstra⁴ , Astrid K Wahl⁵ , Berit R Hanestad⁵ and Erik Fosse¹

¹  The Interventional Centre, Faculty Division Rikshospitalet, Faculty of Medicine, University of Oslo, N-0027 Oslo, Norway

²  Dept of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Sognsvannsveien 20, N-0027 Oslo, Norway

³  Dept of Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Sognsvannsveien 20, N-0027 Oslo, Norway

⁴  Dept. of Biostatistics, Rikshospitalet-Radiumhospitalet Medical Center, Sognsvannsveien 20, N-0027 Oslo, Norway

⁵  The Institute of Public Health/Faculty of Social Sciences, University of Bergen, N-5020 Bergen, Norway

author email corresponding author email

Health and Quality of Life Outcomes 2007, 5:27doi:10.1186/1477-7525-5-27

Published:	24 May 2007

Abstract

Background

Our aim was to investigate the existence of a reciprocal relationship between patients' assessment of quality of life and their appraisal of health. If present, this relationship will interfere with the interpretation of heart surgery's effect on overall quality of life.

Methods

Path analysis was used to investigate reciprocal causal relationships between general health perceptions and overall quality of life before and after heart surgery. Longitudinal data from a study of coronary artery bypass surgery were used to model lagged, cross-lagged, and simultaneous paths over four time-points of assessment from before surgery to one year afterwards. The conceptual framework for the analysis was the Wilson and Cleary causal pathway model. General health perceptions were measured with the Short Form 36. Overall quality of life was measured with i) a single question regarding life satisfaction and ii) the multi-item Quality of Life Survey.

Results

Acceptable model fit was obtained for reciprocal causation between general health perceptions and overall quality of life. Regression coefficients changed over different phases of rehabilitation. Serial correlation accounted for much of the variance within variables over time.

Conclusion

The present analysis demonstrates that unidirectional models of causality are inadequate to explain the effect of heart surgery on overall quality of life. Overall quality of life can causally influence as well as be an outcome of health status after coronary artery bypass surgery.