Table Of ContentDevelopments 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.
