Coronary artery bypass surgery in the elderly: Too often or too seldom? It is a testimony to scientific advances that raising a simple inquiry today, such as whether coronary artery bypass surgery is done too often or too seldom in elderlypatients, requiresanexplorationofwhatviewsonemightholdonseveral medical as well as non-medical issues. Unlike earlier years when doctors were clinically free to decide what should be done with a patient, health has become an expensive human right, decisions about which also involve the patient, the epidemiologist, the health policy administrator, politicians, the exchequer, and the philosopher. In its broadest definition health has come to mean the core of well-being and, therefore, the goal ofany socio-economic system. Until only a decade ago, medical opinion regarding how often coronary artery bypass surgery (CABG) was indicated or useful was unclear. Becauseof multi-organ senescence, the elderly were expected to have a higher rate operative morbidity and mortality and, having crossed an advanced life span, might not live very long after the operation. Decision making on medical grounds first depends on knowing if a patient can survive an operation compared to how long they would survive without it, i. e.
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ISBN-13
978-94-011-0209-4 (9789401102094)
DOI
10.1007/978-94-011-0209-4
Schweitzer Klassifikation
One: Demographics and health policy.- 1. Demographic and economic trends in Europe and the need for coronary bypass surgery.- 2. Do growing proportions of elderly mean more cardiovascular diseases?.- Two: Favourable clinical results of CABG in the elderly.- 3. Isolated CABG in the elderly: Operative results and risk factors over the past three decades.- 4. Combined valve and coronary bypass surgery in the elderly.- 5. Cardiac surgery in the octogenarians: Perioperative results and clinical follow-up.- 6. Coronary artery bypass grafting and use of the LIMA in octogenarians.- Three: Health care costs of elderly CABG patients.- 7. Age-specific costs of heart surgery and follow-up treatment in Germany.- Four: Clinical, economical and ethical controversies.- 8. Opportunities to improve the cost-effectiveness of CABG surgery.- 9. Who gets bypass surgery - should the doctor, patient or computer decide?.- 10. The economics of treatment choice. Making choices in coronary bypass surgery in the elderly.- 11. The role of age and life expectancy in prioritising health care.- 12. When does the cost of living exceed the return on our investment? The social and economic consequences of coronary bypass surgery in the elderly.- Five: The heart of the matter: Health-related quality of life after CABG in the elderly.- 13. Coronary artery bypass surgery and health-related quality of life: Data from the National Health and Nutrition Examination Survey.- 14. The selection of health-related quality of life measures for older adults with cardiovascular disease.- 15. Survival and health-related quality of life of elderly patients undergoing cardiac surgery.- 16. Health-related quality of life after coronary revascularization in older patients.- 17. Longitudinal health-related quality of lifeassessment in five years after coronary artery bypass surgery - does benefit continue with advancing age?.- 18. Health-related quality of life five years after coronary bypass surgery at age 75 or above: A research approach to item selection.- Six: Rehabilitation.- 19. Rehabilitation following coronary artery bypass graft surgery at elderly age.- Discussions.
