Self-responsibility predicts the successful outcome of coronary artery bypass surgery

Coronary heart disease (CHD) is the most common cause of death in the western world (Roberts, 1992). A high incidence of CHD is also reported for the White and the Asian population of South Africa (Wyndham, 1979). Coronary artery bypass graft (CABG) SL ~..;ry continues to be a proven, effective therapy to relieve symptoms of angina, to improve the patient's quality of life and to prolong life in selected patients (Connolly and Guyton, 1992). This intervention is costly and the operative success of coronary revascularization is limited unless the patient understands and will adhere to the prescribed medical regimen, diet and exercise after surgery (Marshall et al, 1986). The problem is compounded as post-operatively, the symptoms of coronary artery disease are ameliorated and the patient may be unaware of the persistence of the disease process. In additlon, the World Health Organisation's definition of cardiac rehabilitation, puts (olward the concept that the patient must accept responsibility for his or her own recovery (Oldridge, 1986). The role that the patient plays post-operatively must therefore become important in the final outcome. In 1977 Ginzberg wrote: "No improvement in the health care system will be efficacious unless the citizen assumes responsibility k~ his/her own well-being", This statement implies that people must take charge of their own health and not abrogate this responsibility to the experts. This study was designed to determine whether the acceptance of selfresponsibility is all important determinant of the successful outcome of corollary artery bypass graft (CABG) surgery. The final study was preceded by five pilot studies to assist in formulating and identifying the concept of selfresponsibility. Questionnaires were designed to determine aspects of improved quality of life and self-responsibility. For the final study. 75 patients who had undergone CABG surgery, were selected from surgical patients in the private as well as the public sector. In order to assess the acceptance of self-responsibility, the spouses/care-givers of the patients were included in this study. Patients were interviewed 4 to 6 days after the operation, and again six months and 12 months later. Successful outcome was measured in terms of improved quality of life using the criteria suggested by the Coronary Artery Surgery Study (Coronary Artery Surgical Study Principal Investigators, 1983). Tine acceptance of self-responsibility was then investigated as a possible factor influencing the improvement of the quality of life of these patients .. It was found that the acceptance of self-responsibility for the successful outcome of CABG surgery was a significant factor in the group of patients with an improved quality of life (p<0.01). From the results of this study, a profile of South African patients with improved quality of life was identified. They are: Men, married, annual income> R50 000 (US $8 000), who had a normal sex-life prior to the operation. They differ significantly from the group without an improved quality of life in the following aspects: they had spent more hours participatinp in sport at school (p=0.04), had stopped their sporting activities for a shorter period of time prior to the operation (p<0.01) and were taller (p<O.01). They were not depressed 12 months after the operation (p<0.01). Patients who accept self-responsibility for their recovery after CABG surgery have the following characteristics: married (p<0.01), have a level of education> grade 12 (p=O.01), have an annual income: R50 000 (p=O.05). They differ from the group who are not responsible in that they and their spouses/care-givers have more knowledge about the disease and the risk factor modification (p=O.01; p<O.01), and twelve months after the operation the patients are satisfied with the outcome of the operation (p<0.01). A stepwise logistic regression established that the acceptance of selfresponsibility was the strongest predictive fsctor for an improved quality of life after CABG surqe.,: Patients who did not accept responsibility would not have an improved quality of life irrespective of the impact of all other parameters. Patients' satisfaction with the outcome of the operative procedure is an important predictor of the acceptance of self-responsibility. Realistic expectations of the outcome of CABG surgery will improve pati-mts' satisfaction with the outcome ..The knowledge of the spouse is a significant factor in the patients' acceptance of self-responsibility. The spouse of a patient is frequently neglected by health- care workers and yet this person is very important for the patient's successful lifestyle change. Knowledge of the chronic nature of their disease as well as risk factor modification and realistic expectations of the outcome of CABG surgery influences patients' acceptance of self-responsibility. Every effort should be made to assist patients in accepting the responsibility for their own recovery so that the outcome of CABG will be successful.
A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, 1998
Eales, Cecelia Johanna (1998) Self-responsibility predicts the successful outcome of coronary artery bypass surgery, University of the Witwatersrand, Johannesburg, <>