Eighty-nine patients receiving cardiac valve replacement or surgery consisting of valve replacement and coronary artery bypass grafts in four teaching hospitals were studied before surgery and again six months after surgery. More than 60 indicators of the quality of life were assessed. The majority of persons showed improvement in physical function, emotional states, and social activity. Of those with exertional angina or dyspnea before surgery, about two thirds were completely relieved at six months after surgery. There was a substantial reduction in number (from 31 to seven) of persons with five or more days of disability per month due to cardiac symptoms. The majority remained the same in their usual level of physical activity, most psychological traits, and attitudes and social support networks. Most previously employed persons returned to work. Improvements in the conditions of patients who had valve surgery closely paralleled those of patients who had undergone coronary artery bypass surgery in the same hospitals.

To evaluate the benefits of coronary artery bypass graft (CABG) surgery, we interviewed and tested 318 patients (268 men and 50 women) younger than age 70 before and six months after elective CABG at four university medical centers. Biomedical, psychoneurological, physical function, role function, occupational, social, family, sexual, emotional, and attitudinal variables were assessed. Quantitative comparisons showed improvement on many factors. Angina was completely relieved for 69% to 85% of persons, depending on whether it had been induced by exertion or other events. Disability days were reduced more than 80%. Seventy-five percent of employed persons had returned to work. Anxiety, depression, fatigue, and sleep problems declined. Vigor and well-being scores rose significantly. When losses were expected (eg, psychoneurological function, marital adjustment), they generally were not found. For none of the more than 60 outcome variables was widespread serious worsening found. The findings suggest that the great majority of patients are able to resume normal economic and social functioning within six months after CABG.

Preoperative predictors of postoperative employment status were studied in 228 patients (aged 25 to 64 years) who underwent cardiac surgery. Of the 150 patients working in the year before surgery, 73% returned within six months. Of those not so employed, 18% started working. Patients who expected preoperatively to return to work did so at an 82% rate compared with 39% of the others. This was a strong predictor in the multiple regression analysis. Educational level and family income were stronger predictors than occupation or level of physical exertion required. Rates of return were higher in patients with less severe angina and less fatigue preoperatively, but did not differ significantly by sex, surgical procedure, or duration of illness. Seven variables predicted work status correctly for 86% of persons. These results suggest that determinants of return to work are largely present before surgery and that patients' attitudes and expectations play an important role.