Work

Health-related quality of life pre-war and during-war in cardiac patients: evidence from a multicenter prospective study – West Bank

Year: 2026

Type: article

Abstract: BACKGROUND: War imposes systemic and psychosocial stressors that can disrupt postoperative recovery and diminish quality of life. Quantitative data examining these effects in cardiac surgery populations remain scarce. OBJECTIVES: To assess whether the wartime period following October 7, 2023, independently affected postoperative health-related quality of life (HRQoL) among patients undergoing coronary artery bypass grafting (CABG) or valve surgery in Palestine. METHODS: In this prospective multicenter cohort, 1,686 patients who underwent cardiac surgery between September 2022 and May 2025 were screened. After exclusion of 486 ineligible or non-followed participants, 1,200 patients were included: 465 operated pre-war and 735 during-war. HRQoL was evaluated using the 12-Item Short-Form Health Survey (SF-12), generating Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores. Associations between wartime exposure and SF-12 outcomes were analyzed using generalized linear models (GLMs) with robust standard errors and validated through propensity score matching (PSM, 1:1 nearest neighbor) matching on age, gender, diabetes, surgery type, cardiopulmonary bypass time, and hospital fixed effects. RESULTS: Open-heart procedures increased by 5% monthly during-war. Postoperative complications were generally more frequent in this period, with notable rises in acute kidney injury (33.8% vs. 22.4%), atrial fibrillation (31.9% vs. 24.8%), and surgical site infection (8.8% vs. 4.1%). Mean PCS and MCS values were significantly lower during-war (p = 0.037 and p = 0.013, respectively). In adjusted GLMs, wartime exposure remained independently associated with reduced HRQoL (β = − 1.31 [95% CI − 3.27 to − 0.65] for PCS; β = − 1.19 [95% CI − 3.12 to − 0.75] for MCS). PSM confirmed these findings (PCS = − 1.47 [95% CI − 2.89 to − 0.06], p = 0.041; MCS = − 1.82 [95% CI − 3.67 to 0.04], p = 0.056). CONCLUSIONS: Wartime conditions were independently associated with clinically relevant reductions in both physical and mental postoperative quality of life. Sustained access to rehabilitation, psychosocial support, and follow-up care is crucial to preserving recovery among cardiac surgery patients in conflict-affected settings. CLINICAL TRIAL NUMBER: Not applicable.

Source: Health and Quality of Life Outcomes

DOI: 10.1186/s12955-026-02506-y