Symptom Trajectories in Coronary Artery Bypass Graft Patients With or Without Pre-operative Heart Failure

Introduction: Coronary artery bypass grafting (CABG) is a common intervention for coronary artery disease worldwide. Limited information is available about symptom trajectories of patients with pre-existing heart failure (HF) during recovery postCABG. Hypothesis: The hypothesis of the study was that HF patients have greater improvements in trajectories of symptoms following CABG than those without HF. Methods: A prospective repeated measurement design was used for this study. Symptoms were measured by the Cardiac Symptom Survey instrument at baseline before CABG, and 1 week, 6 weeks, and 3 months following CABG. Generalized estimating equation with mixed models was used for analysis. Results: There were 167 non-HF patients and 56 pre-existing HF patients who underwent CABG from 6 medical centers in the study. Angina, dyspnea, fatigue, depression, sleep problems, surgical pain, swollen legs, palpitation, anxiety, and poor appetite all significantly improved after CABG in both groups. Interestingly, patients with pre-existing HF had greater improvement in symptom trajectories for dyspnea, anxiety and poor appetite than non-HF patients. Improvement in dyspnea in patients with pre-existing HF was significantly greater at one week (B5-1.08, p50.036), 6 weeks (B5-1.37, p50.011) and 3 months (B5-1.31, p50.009) after CABG. Similarly, improvement in anxiety was significantly greater at 3-months (B5-0.93, p50.049). They also had greater improvements in appetite at 6 weeks (B5-0.88, p50.017) and 3 months (B5-0.85, p50.018) than non-HF patients. Conclusions: Patients with HF experienced equal or greater improvement in distressing symptoms after CABG surgery. These results demonstrate that CABG can greatly reduce symptom burden in patients with pre-existing HF.