The control patients were matched for sex, age at time of surgery and the type of surgery performed. The control group was selected based on the type of surgical procedure to keep this variable constant, which can influence the comparison of outcomes. After patients gave their informed consent to study participation, the questionnaires were sent by post and self-administered by the patients. The results were collected over a telephone interview. The evaluation is done by means of a questionnaire based on daily life during the 2 weeks prior and consists of 27 issues investigating the physical, emotional and social spheres of everyday life.
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Finally a global score, rated on a 7 points scale obtained by means of an average of each score, is determined. Mortality data and the quality of life questionnaire were collected by telephone interview.
We performed an analysis of data using the Statistical Package for Social Science software v. Kolmogorov-Smirnov test was applied to verify the normality of the distribution of the continuous variables. Continuous variables were compared using Student t test or Mann Whitney test as appropriate.
Survival was analyzed using the Kaplan Meier method and the data were compared with the log-rank test. Median follow up time was estimated as the time corresponding to the 50th percentile taken from reverse Kaplan Meier analysis. JhW group consists of 31 patients who underwent a variety of cardiac surgeries including elective and emergency surgery. We compared them to a control group of 62 patients. Patients were operated between January and December Among the 93 patients included in this study, 11 patients were lost to follow-up all in the control group.
The median follow-up were The actuarial survival curves of the two groups are completely superimposed: no significant difference in survival was demonstrated by analysis of Kaplan Meier curves Fig. The evaluation of quality of life was based on the 44 survivors 17 JhW and 27 controls. Three refused to answer the MacNew quiz JhW 2 and 1 control and 9 others were unable to respond due to dementia JhW 1 and 8 control. Therefore, 32 patients in total participated in the evaluation of the quality of life with the MacNew JhW 14 patients and 18 control. The MacNew scores were similar for both populations.
Results are expressed in Fig. The results are expressed in absolute value in Table 2.
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The assessment of HRQL is an increasingly important outcome in the management and care of cardiac patients [ 5 ]. Quality of life is a very broad concept, multidimensional and subjective which can be difficult to evaluate correctly.
The MacNew questionnaire is a specific instrument for cardiovascular disease [ 5 , 11 ]. It takes into account physical, psychological, relational as well as more specific issues such as sexuality and self-image. Currently validated in 23 languages, the MacNew is a reference tool in many studies. It intervenes in setting the therapeutic point of coronary heart disease medical treatment, percutaneous angioplasty, bypass surgery, implantable defibrillator, pacemaker in rehabilitation strategies and secondary prevention after heart failure, myocardial infarction, angina and cardiac surgery.
Our evaluation method had to be adapted to French speaking patients, which is the case of MacNew [ 6 ]. This questionnaire was also validated after rehabilitation in cardiac surgery [ 12 ]. In the literature there are several discussions regarding the modality of administration of this type of questionnaire interview, self-administration. Some studies conclude that different modes of administration of questionnaire do not lead to the same understanding of the issue and may affect the response provided.
Therefore, care must be taken in interpreting the results in the administration of the questionnaire. We have been attentive to this aspect and have taken the necessary precautions so that the mode of administration of the questionnaire is identical for each patient of our study.
Many studies show the feasibility of cardiac surgery in JhW patients [ 13 , 14 , 15 , 16 ] but very few evaluate its long-term results. The only long-term outcome evaluated in a cohort of patients over a year period was based on patient survival and the occurrence of new cardiac events [ 3 ]. For the first time we report an evaluation of the quality of life of JhW patients after heart surgery and compare it to a control population. We lack the data for the 11 patients lost to follow-up. We could not assess the quality of life in 9 patients with dementia too advanced for them to respond to the interview.
However, we believe that this condition has no connection with the refusal of transfusion during surgery: only one of them was a JhW. The quality of life assessed by the questionnaire was identical in the JhW population and the control population. The scores observed in both groups are close to the scores reported in the literature in patients after rehabilitation for treated coronary events [ 6 ].
There are many methods to analyze the long-term mortality of a population. The method used here is considered as the most robust: a reversed Kaplan Meier survival curve.
The actuarial survival curves of JhW patients and control patients are totally superimposable. This can be explained by the fact that JhW patients we studied differs significantly from other studies for surgeries performed. In our study, we find a wide variety of surgical procedures at high risk, including emergencies, reoperations and combinations of several techniques at the same operation. Anyway, our JhW population has the same life expectancy as our control population. One must consider in the interpretation of the results that both groups are small and heterogeneous.
This is particularly relevant for the assessment of the quality of life: only 14 and 18 patients responded to the MacNew questionnaire in the JhW and control group respectively.
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Future multi-institutional series are highly recommended to support our results and conclusions. Overall long-term quality of life and survival in the JhW group were similar to the control group. Comparison of outcome in Jehovah's witness patients in cardiac surgery: an Australian experience. Heart Lung Circ. Outcomes from cardiac surgery in Jehovah's witness patients: experience over twenty-one years. J Cardiothorac Surg.
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Outcome of patients who refuse transfusion after cardiac surgery: a natural experiment with severe blood conservation. Arch Intern Med. Comparisons of cardiac surgery outcomes in Jehovah's versus non-Jehovah's witnesses. Am J Cardiol. The MacNew heart disease health-related quality of life instrument: a summary. Health Qual Life Outcomes. Validation of the French version of the MacNew heart disease health-related quality of life questionnaire.
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Arch Cardiovasc Dis. Long-term health-related quality of life and survival after cardiac surgery: a prospective study. J Thorac Cardiovasc Surg. Preoperative determinants of quality of life a year after coronary artery bypass grafting: a historical cohort study. Patients with a prolonged intensive care unit length of stay have decreased health-related quality of life after cardiac surgery. Buddhism A way of living based on the teachings of Siddhartha Gautama.
Christianity The world's biggest faith, based on the teaching of Jesus Christ. Hinduism A group of faiths rooted in the religious ideas of India. Islam Revealed in its final form by the Prophet Muhammad.
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Jainism An ancient philosophy and ethical teaching that originated in India. Jehovah's Witnesses A Christian-based evangelistic religious movement. Judaism Based around the Jewish people's covenant relationship with God. Paganism Contemporary religions usually based on reverence for nature. Rastafari A young religion founded in Jamaica in the s. Santeria Afro-Caribbean syncretic religion originating in Cuba. Shinto Japanese folk tradition and ritual with no founder or single sacred scripture.
Spiritualism Spiritualists believe in communication with the spirits of people who have died. Taoism An ancient tradition of philosophy and belief rooted in Chinese worldview. Unitarianism An open-minded and individualistic approach to religion.