Coronary artery bypass surgery, or CABS, is one of the most common surgical procedures for treating patients with coronary artery disease (CAD). A significant number of patients have accelerated atherosclerosis in the postsurgical period and require second and third operations. Moreover, relative to standard medical care, CABS does little to prolong life. The major benefit of the procedure is improving life quality. Thus, to enhance this major benefit of CABS, it is important to understand the factors, psychosocial as well as biological, that might enhance quality of life after CABS. The few available studies on the psychosocial aspects of recovery from CABS suggest that person variables evident prior to surgery are related to postsurgery quality of life. Of special interest here are gender, optimism, Type A, with its component behavior of hostility, and repressive style. The significance of these attributes derives from their theoretical and empirical relationships to the patient's illness representations and correspondent coping responses, and/or their relationship to risk for coronary heart disease (CHD). In addition to person variables, a number of environmental variables might also be expected to play a role in recovery. Variables such as socioeconomic status (SES), major life events, and quantity and quality of social support systems have all been shown to impact on health and illness. Moreover, from a slightly different perspective, the patient's illness itself can serve as an environmental variable impinging on the life of the person providing the primary support. Thus, it is also important to understand how the patient's illness impacts on the provider of the primary support. We propose to study the person and environmental factors that may determine the short-term and long-term sequelae of CABS. 360 patients between the ages of 25 and 70 who are scheduled for elective surgery at a major local hospital will be evaluated two weeks prior to surgery on the day prior to surgery, and one week, six months, and 2 1/2 years postsurgery. Primary support persons will be evaluated three times--at intake, 6 months postsurgery, and 2 1/2 years postsurgery. Medical information will be obtained that will permit us to examine the influences of psychosocial variables on recovery, independent of major risk factors for CAD. Major person variables under investigation will be optimism, Type A, hostility, gender, repressive style, and to a lesser extent, anxiety, and neuroticism. Major environmental variables include quality and quantity of social support and availability of a primary support person. Main outcome variables for patients will include satisfaction with different life domains, depression, return to work, normalization of life style, and new and recurrent morbidity. Main outcome variables for the support person will include perceptions of burden, depression, and life satisfaction.
