eComment: Even the elderly post-CABG patients have a better HRQoL postoperatively

According to your excellent study, male patients under 75 years old and female patients under 70 years old, with good ventricular function and without other co-morbidity, might obtain the best prospect for better health-related quality of life (HRQoL) [1]. In fact, it is evident from Table 2 of your study, that while the mean age in the group of low-, and medium-risk was 59 and 69, respectively, in the high-risk group it was 75.6 years [1]. Despite this fact, clinical improvement was observed in 46.8% of low-risk patients, in 34.8% of medium-risk patients and in 33.3% of high-risk patients, respectively. However, the differences were not significant among the 3 study groups, even at 36 months. The above finding is important because several studies have reported that in elderly patients – in whom a higher comorbidity usually exists – an increased incidence of postoperative greater worry and depression has been observed [2], severe emotional problems, and therefore a worse HRQoL, at least for 12 months postoperatively [3]. Contrary to this, we have demonstrated in a small number of elderly patients (mean age 72.9) that at 12 months following the operation, 80.4% of patients experienced an improvement in their reported HRQoL, in spite of the fact that nearly one in two patients reported neuro-cognitive problems that were present at 12 months postoperatively [4]. Moreover, despite the high incidence of early postoperative complications (up to 66.6%), HRQoL was significantly improved at 4 months after the operation (P<0.001) and continued being improved to a lesser degree one year afterwards (P<0.001).