The 1990s 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 leading experts 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. Clinical issues and operative results complement national costs and quantitated benefits in terms of quality of life as a justification of surgery. The book is addressed to cardiologists, geriatricians, cardiac surgeons, psychiatrists, rehabilitation physicians and public health-care administrators.

The technical evolution of cardiac surgery in the last decades has been rewarded with long-term survival with few complications. A matching improvement in the quality of this survival as subjectively felt by the patient has now become most important to assess the justification of surgery. This book is the summary of the proceedings of an international symposium which addressed the growing demand in this facet of cardiac surgery. For the first time quality of life after valve replacement, coronary bypass, surgery for congenital heart disease, and heart transplantation has been extensively analyzed in terms of the physiological state, intellectual functioning, emotional state, performance of social roles and general satisfaction. The patient's well-being has become the focus of a joint effort of cardiologists, surgeons, general practitioners, psychologists, sociologists and occupational physicians, for all of whom this book offers a guide to the improvement of our patients' Quality of life after open heart surgery'.

primary goal of all forms of therapy is not just prolonging life, but improving the quality of life, has forced analysis of what constitutes quality of life, a concept whose structure pervades all walks of life and eludes definition. Global well being, happiness, morale, vitality, fullness of social life, and satisfaction must be integrated and assessed for the effects of the disease and the therapy, in the context of specific personality traits, attitudes to life, family situation, and socio-economic and political freedom. A growing inter est in research on this subject has led to a clearer understanding of the components which come to determine quality of a patient's life, and how they can be measured in a reproducible manner so that valid comparisons can be made. Keeping these recommendations of analysing quality of life within the context of patients who have undergone open heart surgery, it seemed appro priate to me to separate the influence of various forms of open heart surgery into five aspects of life which can comprehensively reflect the quality of life outcome of the operation. These five 'components' are (1) Physiological state, which summarises the traditionally reported incidence of operative mortality and morbidity, objectively and subjectively measured physical ca pacity, and the residual symptoms, treatment and long-term survival. (2) Intellectual functioning relates to the psychoneurolgocial deficit in memory, reasoning or judgement because of cerebral microembolism and hypo perfusion during cardiopulmonary bypass.

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.