Coronary Bypass Surgery in the Elderly: Ethical, Economical and Quality of Life Aspects PDF
Preview Coronary Bypass Surgery in the Elderly: Ethical, Economical and Quality of Life Aspects
Developments in Cardiovascular Medicine VOLUME 161 ThetitLespublishedinthisseriesareListedattheendofthisvoLume. Coronary Bypass Surgery in the Elderly Coronary Bypass Surgery in the Elderly Ethical, Economical and Quality of Life Aspects Edited by PAULJ. WALTER Department 0/ Cardiovascular Surgery, University Hospital Antwerp, Antwerp, Belgium With a/oreword by Nanette K. Wenger Emory University School 0/ Medicine, Atlanta, Georgia, USA SPRINGER-SCIENCE+BUSINESS MEDIA, B.V. Library of Congress Cataloging-in-Publication Data Coronary bypass surgery in the elderly ethical, economical, and quality of ltfe aspects I edtted by Paul J. ~alter. p. cm. Inc I udes index. Based on a conference held March 9-11, 1994 tn Antwerp, Belgium. ISBN 978-94-010-4093-8 ISBN 978-94-011-0209-4 (eBook) DOI 10.1007/978-94-011-0209-4 1. Coronary artery bypass--Deciston maktng--Congresses. 2. Aged -Surgery--Decision maktng--Congresses. 3. Coronary artery bypass- -Economtc aspects--Congresses. 4. Coronary artery bypass--Moral and ethtcal aspects--Congresses. 5. Oual tty of I ife--Congresses. 1. ~alter, P. J. (Paul J.J, 1935- . [DNLM: 1. Coronary Artery Bypass--in old age--congresses. 2. Coronary Artery Bypass--economlcs--congresses. 3. Ethlcs, Medlcal--congresses. ~1 DE997VME v. 161 1995 I ~G 169 C8219 19951 RD598.35.C67C686 1995 617.4' 12059'0846--dc20 DNLM/DLC for Llbrary of Congress 94-37708 ISBN 978-94-010-4093-8 Printed on acid-free paper All Rights Reserved © 1995 Springer Science+Business Media Dordrecht Originally published by Kluwer Academic Pub1ishers in 1995 Softcover reprint ofthe hardcover 1st edition 1995 No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, inciuding photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner. Table of Contents List ofContributors IX Preface xiii Foreword by Nanette K. Wenger xix Part One: Demographics and health policy 1. Demographic and economic trends in Europe and the need for coronary bypass surgery 3 Markus Schneider 2. Do growing proportions ofelderly mean more cardiovascular diseases? 13 Hans Hoffmeister and Lee Muecke Part Two: Favourable clinical resultsofCABG in theelderly 3. Isolated CABG in the elderly: Operative results and risk factors over the past three decades 27 Wilbert J. Keon 4. Combined valve and coronary bypass surgery in the elderly 41 Janos Szecsi, Paul Herijgers, lIse Scheys and Willem Flameng 5. Cardiac surgery in the octogenarians: Perioperative results and clinical follow-up 55 Francis Fontan, Alain Becat, Guy Fernandez, Nicolas Sourdille, Pascal Reynaud and Paul Montserrat VI Table ofContents 6. Coronary artery bypass grafting and use ofthe LIMA in octogenarians 61 Gideon Sahar, Ehud Raanani, Itzhak Hertz, Ron Brauner and Bernardo A. Vidne PartThree: Healthcare costs ofelderly CABG patients 7. Age-specific costs ofheart surgery and follow-up treatment in Germany 71 DetlefChruscz and Wolfgang Konig Part Four: Clinical, economical and ethical controversies 8. Opportunities to improve the cost-effectiveness ofCABG surgery 79 William B. Stason 9. Who gets bypass surgery - should the doctor, patient or computer decide? 91 John Kellett 10. The economics oftreatment choice. Making choices in coronary bypass surgery in the elderly 101 Alan Maynard 11. The role ofage and life expectancy in prioritising health care III John Harris 12. When does the cost ofliving exceed the return on our investment? The social and economic consequences ofcoronary bypass surgery in the elderly 121 Roger W. Evans Part Five: The heart ofthe matter: Health-related quality oflife after CABG in the elderly 13. Coronary artery bypass surgery and health-related quality oflife: Data from the National Health and Nutrition Examination Survey 137 PenniferErickson 14. The selection of health-related quality oflife measures for older adults with cardiovasculardisease 145 Sally A. Shumaker and Roger Anderson Table ofContents vii IS. Survival and health-related quality oflife ofelderly patients undergoing cardiac surgery ISS Noreen Caine, Susan Tait and John Wallwork 16. Health-related quality oflife aftercoronary revascularization in older patients 167 Paul D. Cleary, Edward Guadagnoli and John Z. Ayanian 17. Longitudinal health-related quality oflife assessment in five years aftercoronary artery bypass surgery - does benefitcontinue with advancing age? 179 Ravinder Mohan, Paul J. Walter and Erik van Hove 18. Health-related quality oflife five years after coronary bypass surgery at age 75 or above: A research approach to item selection 195 Paul J. Walter, Ravinder Mohan and Chris Cornelissen Part Six: Rehabilitation 19. Rehabilitation following coronary artery bypass graft surgery at elderly age 213 Nanette K. Wenger Discussions 223 Index 259 List of contributors Noreen Caine Director of Research and Development, Papworth Hospital NHS TRUST, Papworth Everard, Cambridge CB3 8RE, U.K. Co-authors: Susan Tait and John Wallwork Paul D. Cleary Department of Health Care Policy, Harvard Medical School, Parcel B, 25 Shattuck St., Boston, MA 02115, U.S.A. Co-authors: Edward Guadagnoli and John Z. Ayanian DetlefChruscz BKK BV, Koperschaft des Offenliches Rechts, Kronprinserstr. 6, D-45128 Essen, Germany Co-author: Wolfgang Konig Pennifer Erickson Clearinghouse on Health Indexes, QA EHP, National Center for Health Statistics, Room 730, 6525 Belcreast Road, Hyattsville, MD 20782, U.S.A. Roger W. Evans Head, Section ofHealth Services Evaluation, Department ofHealth Sciences Research, Mayo Clinic, 200 First Street, Rochester, MN 55905, U.S.A. Willem Flameng Department of Cardiac Surgery, Gashuisberg University Clinic, University Hospital ofLouvain, Herestraat 49, B-3000 Louvain, Belgium Co-authors: Janos Szecsi, Paul Herijgers and Ilse Scheys Francis Fontan Department ofCardiovascular Surgery, Clinique Saint-Augustin, 114 Avenue D'Ares, F-33000 Bordeaux Cedex, France Co-authors: Alain Becat, Guy Fernandez, Nicolas Sourdille, Pascal Reynaud and Paul Montserrat IX P.J. Walter(ed.), CoronaryBypassSurgeryintheElderly,pp.ix-xi. x List ofcontributors John Harris TheCentrefor SocialEthicsand Policy, UniversityofManchester, Humanities Building, Oxford Road, Manchester Ml3 9PL, U.K. H. Hoffmeister Director, Institute for Social Medicine, & Epidemiology, German Institute of Health, P.O. Box 33 00 13, D-14191 Berlin, Germany Co-author: L. Muecke John Kellett Consultant Physician, Nenagh General Hospital, Nenagh, County Tipperary, Ireland Wilbert J. Keon Division ofCardiovascularand Thoracic Surgery, University ofOttawa Heart Institute, 1053 Carling Avenue, Ottawa, Ontario, Canada KIY 4E9 Alan Maynard CentreforHealthEconomics,UniversityofYork, Heslington,YorkYOI 5DD, U.K. Ravinder Mohan Department ofCardiovascular Surgery, University ofAntwerp, Wilrijkstraat 10, B-2650 Antwerp/Edegem, Belgium Co-authors: Paul J. Walter and Erik Van Hove Markus Schneider Director BASYS, Advisory Bureau For Applied System Research, Reisingerstrasse 25, D-86159 Augsburg, Germany Sally A. Shumaker DepartmentofPublicHealthSciences,TheBowmanGraySchoolofMedicine, Wake Forest University, Medical Center Boulevard, Winston Salem, NC 27157, U.S.A. Co-author: Roger Anderson William B. Stason 29 Sandy Pond Road, Lincoln, MA 01773, U.S.A. Bernardo A. Vidne Division of Cardiothoracic Surgery, Sackler School of Medicine, Beinson Medical Center, Tel-Aviv University, 49100 Petah-Tikva, Israel Co-authors: Gideon Shar, Ehud Raanani, Itzhak Hertz and Ron Brauner List ofcontributors Xl Paul J. Walter Department of Cardiovascular Surgery, University Hospital of Antwerp, Wilrijkstraat 10, B-2650 Antwerp/Edegem, Belgium Co-authors: Ravinder Mohan and Chris Cornelissen Nanette K. Wenger Division of Cardiology, Emory University School of Medicine, Grady Memorial Hospital, 69 Butler Street, S.E., Atlanta, GA 30303, U.S.A.
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