UK Survey: The Patient Perspective.
Understanding heart surgery
Between 2016 and 2019, an average of 34,000 cardiac surgeries were performed on adults each year in the UK and Ireland. The most common types of cardiac surgeries are listed below:
- Coronary Artery Bypass Grafting (CABG): CABG is the most common form of heart surgery in the UK, carried out for patients experiencing a narrowing or blockage in the coronary arteries.
- Isolated first-time Aortic Valve Surgery (AVR), joint AVR & CABG surgery, and Transcatheter aortic valve implantation (TAVI):
- AVR is a form of open heart surgery to replace a faulty or damaged aortic valve with an artificial heart valve. The aortic valve helps to regulate the flow of blood through the heart.
- TAVI is an alternative to valve replacement surgery for individuals for whom open heart surgery may be too risky. It involves fitting a valve into the heart via a blood vessel in the leg or the chest to treat a narrowing of the aortic valve opening.
- Mitral Valve Surgery: The mitral valve is a small valve that ensures blood flows in the right direction. If the mitral valve isn’t working properly or is damaged, it can be repaired or replaced through open heart surgery.
- Major thoracic aortic procedures, for example, surgery for aortic aneurism: Surgery carried out on the aorta, the main artery that carries blood from the heart to the rest of the body, to help relieve pressure and reduce the risk of rupturing when an aneurism or swelling occurs.
Introduction to ERAS Cardiac
ERAS® stands for Enhanced Recovery after Surgery. ERAS Cardiac is a non-profit organisation with the mission to provide hospitals with better guidance for developing local protocols, which are part of a continuous quality improvement process for better patient care, and to reduce postoperative complications after heart surgery.
ERAS Cardiac was established in 2017 by a group of cardiac surgeons, anaesthesiologists and intensive care specialists. It is part of the ERAS® Society, an international organisation with enhanced recovery guidelines for several surgical sub-specialties, and is comprised of multinational experts representing all aspects of healthcare delivery.
To better understand perceptions of heart surgery, ERAS Cardiac surveyed cardiac surgery patients and the general public in the United Kingdom. Patients were asked about their experiences of undergoing heart surgery, while the public survey explored perceptions of heart surgery and the associated risks. The patient survey was conducted between 18 December 2020 and 4 May 2021; 80 NHS patients who underwent cardiac surgery between 2016 and 2019 participated in the survey. The general public research was conducted among 2,050 adults in Great Britain between 27 and 28 May 2021.
The results of the patient survey suggest that NHS patients undergoing cardiac surgery have a high level of overall satisfaction with their experience. It also showed that there were areas – especially after surgery – where support could be improved.
The general public were positive about the care they believed they would receive from the NHS if undergoing heart surgery. The research did, however, reveal some misconceptions about heart surgery and the associated risks.
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National Institute for Cardiovascular Outcomes Research (NICOR), 2020: 1
Main findings from the research
Research among the general public shows that there is high confidence that patients who undergo heart surgery can make a full recovery: 68% of Brits would be confident that they would make a full recovery if they underwent heart surgery. Despite this, several findings emerged from the survey results that showed there may be some misunderstandings relating to heart surgery and the associated risks.
Most Britons dramatically underestimate the survival rate for heart surgery
Cardiac surgery has come a long way over the past 20 years, and it can offer significant life-enhancing benefits to patients. It can reduce disability, alleviate physical symptoms, prolong life, and improve quality of life.
However, the results of the public survey showed that fewer than 10 per cent of Brits accurately estimated the survival rate from heart surgery, which is above 97 per cent.
The patient survey highlighted there is also a low level of understanding about the survival rate among patients. Only 69% of the patients surveyed said they had a good understanding of the survival rate from heart surgery before their procedure – meaning 31% did not feel they had a good understanding. And only 29% of patients correctly estimated that the survival rate for heart surgery overall is between 90-100%.
Britons are unsure about who can have heart surgery and when it would be recommended to them
One third of Britons (33%) believe that heart surgery is only used as a last resort of treatment. In fact, heart surgery can improve the quality of life and relieve symptoms for a range of patients.
Heart surgery is not always an urgent or emergency procedure. It can also be an elective procedure, where both the patient and surgeon have agreed that the procedure has a strong likelihood of improving the patient's overall health. For example, of the 14,098 coronary artery bypass graft surgeries conducted in the UK in 2018/19, approximately half (6,996) were elective.
Similarly, one third of Brits (32%) believe that someone could be too old to have heart surgery. Whilst heart surgery can be more complex with older patients, surgeons do not have a set upper age limit for procedures.
Brits overestimate the risk of complications from heart surgery
Results from the public research showed that Brits overestimate the likelihood of complications occurring during heart surgery. For example, a quarter of Brits (27%) believe there is a high risk that heart surgery will lead to a stroke. Recent research for coronary artery bypass graft surgeries – the most common type of heart surgery - reported that the post-operative rate for strokes was less than 1.0%.
People overestimate the recovery period following heart surgery
Our research with the public shows that nearly a quarter of Brits (23%) think that heart surgery requires hospitalisation for several weeks. In reality, hospitalisation is likely to be far shorter. The average hospital stay is just 9 days for patients aged 80 or over, and is shorter still for those in younger age groups.
Conclusion
Our patient research demonstrates that there is a high rate of satisfaction with the overall outcomes from heart surgery (86% of patients were satisfied). In addition, 71% patients reported improvement in their physical health following surgery, 45% in their mental health and 70% in their overall quality of life. Along with these positive results, both the patient and public surveys show there are opportunities to provide more information about heart surgery, its outcomes, and the patient journey. “It is great to see such high levels of patient satisfaction and we know the difference heart surgery can make to patients’ lives. However, many are still nervous about making the decision on whether or not to have surgery. Poor understanding of what these operations involve and the risks associated with them do not help with this. I hope that this research helps to bust some of the unhelpful myths that exist around heart surgery.”
Survey details
The findings on this page are based on the results of two surveys conducted by ERAS Cardiac in 2021:
- Patient survey: Total sample size was 80 patients who have undergone either elective or emergency heart surgery on the NHS between January 2016 and December 2019. Fieldwork was conducted between 18th December 2020 – 4th May 2021. The survey was carried out online. Respondents were recruited via two methods: a) an established patient research panel; and b) via the ERAS Cardiac Surgeon Network (surgeons belonging to the network shared the survey link with patients). It was commissioned by ERAS Cardiac and funded by one of ERAS Cardiac’s corporate partners, Edwards Lifesciences.
- General public research: All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2,050 adults. Fieldwork was undertaken between 27th - 28th May 2021. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).