Emory Researchers Find Gender Differences in Bypass Recovery: Social
Factors Might Hold Key to Women's Elevated Risk
ATLANTA -- A study published
today in the Journal of the American College of Cardiology concludes
that women have a more difficult recovery compared with men after coronary
artery bypass surgery (CABG) -- and severity of illness, pre-surgery
health and other medical factors do not fully explain this gender difference.
The research team of Emory
and Yale scientists studied 804 men and 309 women who underwent first
CABG at Yale New Haven Hospital between February 1999 and February 2001.
The patients were interviewed after surgery between six and eight weeks
after their bypass procedures; additional information was obtained from
their medical records.
"Although serious post-operative
complications were rare, those we noted after discharge, up to six to
eight weeks after the surgery -- including readmissions, surgery-related
symptoms and side effects and infections -- were more common in women
than men," says principal investigator Viola Vaccarino, MD, PhD, of
the Emory Department of Medicine's Division of Cardiology. "We also
found physical function (PF) remained unchanged and symptoms of depression
improved in men, compared to the corresponding levels before surgery.
However, in women there was a significant decline in PF and an increase
in symptoms of depression following CABG."
According to Dr. Vaccarino,
pre-existing conditions and risk factors did not explain the differences
in recovery by gender noted in the study. In fact, women actually had
fewer diseased coronary arteries than the men. So what could explain
the higher rate of problems experienced by women post- CABG? "One possibility
is that CABG is a less effective procedure in women compared with men,"
answers Dr. Vaccarino. "Most previous studies have examined in-hospital
mortality and complications, and although results are somewhat divided,
several reports have indicated that women have worse outcomes. Few previous
studies, however, have looked at a global range of health measures after
CABG as we did in this paper. Our results could be in line with a less
optimal response from this procedure in women than in men, at least
in the short term."
Another possible explanation
is that women might have less social and family support than men during
their recovery phase, Dr. Vaccarino explains. She points out that more
women than men in the study lived alone and were single. In addition,
younger women -- who might have more home responsibilities -- tended
to have worse outcomes after CABG than older women.
"Some of the problems experienced
by the women in the study could be the result of 'overdoing it' during
the recovery period and not getting adequate rest or nutrition. Logically,
it makes sense that the differences might be due to a combination of
home/caregiver responsibilities and lack of help or support," states
Dr. Vaccarino. "However, these are things that are difficult to measure."
Dr. Vaccarino believes the
study is particularly important because it could help physicians --
and their female patients -- understand areas of vulnerability during
the recovery phase following CABG and develop interventions for women
to improve recovery. "For example, women might need more social and
family support and symptoms of depression should be recognized early
and treated," says Dr. Vaccarino.
She adds that more research
is needed to further understand the role gender plays in recovering
from bypass surgery. "We need to know if differences between men and
women during the recovery phase of CABG persist over time. For example,
it could be that women take longer to recover, but in the end they catch
up. We are now in the process of examining a longer follow-up of these
patients to find out," Dr. Vaccarino says.
The Emory Heart Center
is comprised of all cardiology services and research at Emory University
Hospital (EUH), Emory Crawford Long Hospital (ECLH) Carlyle Fraser Heart
Center, the Andreas Gruentzig Cardiovascular Center of Emory University
and the Emory Clinic. Ranked in the top ten of U.S. News & World Report's
annual survey of the nation's best Heart Centers, the Emory Heart Center
has a rich history of excellence in all areas of cardiology -- including
education, research and patient care. It is also internationally recognized
as one of the birthplaces of modern interventional cardiology.