Coronary Bypass Surgery in the Elderly: Ethical, Economical and Quality of Life Aspects (Developments in Cardiovascular Medicine, 161)

Front Matter....Pages i-xx Front Matter....Pages 1-1 Demographic and economic trends in Europe and the need for coronary bypass surgery....Pages 3-12 Do growing proportions of elderly mean more cardiovascular diseases?....Pages 13-23 Front Matter....Pages 25-25 Isolated CABG in the elderly: Operative results and risk factors over the past three decades....Pages 27-40 Combined valve and coronary bypass surgery in the elderly....Pages 41-53 Cardiac surgery in octogenarians: Perioperative results and clinical follow-up....Pages 55-59 Coronary artery bypass grafting and use of the LIMA in octogenarians....Pages 61-68 Front Matter....Pages 69-69 Age-specific costs of heart surgery and follow-up treatment in Germany....Pages 71-76 Front Matter....Pages 77-77 Opportunities to improve the cost-effectiveness of CABG surgery....Pages 79-89 Who gets bypass surgery — should the doctor, patient or computer decide?....Pages 91-100 The economics of treatment choice....Pages 101-109 The role of age and life expectancy in prioritising health care....Pages 111-119 When does the cost of living exceed the return on our investment?....Pages 121-134 Front Matter....Pages 135-135 Coronary artery bypass surgery and health-related quality of life: Data from the National Health and Nutrition Examination Survey....Pages 137-144 The selection of health-related quality of life measures for older adults with cardiovascular disease....Pages 145-154 Survival and health-related quality of life of elderly patients undergoing cardiac surgery....Pages 155-166 Health-related quality of life after coronary revascularization in older patients....Pages 167-177 Longitudinal health-related quality of life assessment in five years after coronary artery bypass surgery — does benefit continue with advancing age?....Pages 179-194 Health-related quality of life five years after coronary bypass surgery at age 75 or above....Pages 195-210 Front Matter....Pages 211-211 Rehabilitation following coronary artery bypass graft surgery at elderly age....Pages 213-221 Back Matter....Pages 223-268 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. The nineties have been characterized by a reappraisal of allocating expenditure for health care interventions. Coronary artery bypass in the elderly has emerged as an example of burgeoning expensive surgery whose appropriateness is under challenge. This book comprises the proceedings of an international symposium where world renowned leaders in aspects such as health economics, ethics, clinical cardiology, cardiac surgery, epidemiology, and health care policy discussed the need and outcome of the operation in old and very old patients. No other book has hitherto addressed this increasingly quoted intervention in debate on the right to health care for the elderly citizen. Clinical issues and operative results complement national costs and quantitated benefits in terms of quality of life as a justification for surgery. The book is addressed to cardiologists, geriatricians, cardiac surgeons, psychiatrists, rehabilitation physicians and public health care administrators This book comprises the proceedings of an international symposium where leading experts in aspects such as health economics, ethics, clinical cardiology, cardiac surgery, epidemiology and health-care policy discussed the need and outcome of this operation in old and very old patients.