Health‐Related Quality of Life in Patients Undergoing Cardiac Surgeries in Low‐ and Lower‐Middle‐Income Countries: A Systematic Review and Meta‐Analysis

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Objective Health‐related quality of life (HRQoL) assessment is pivotal for advancing sustainable global cardiac surgery. However, the use and applicability of HRQoL instruments in low‐ and lower‐middle‐income countries (LI‐LMICs) remain poorly characterized. Methods A systematic review of studies assessing HRQoL among patients undergoing cardiac surgery in LI‐LMICs was performed using PubMed/MEDLINE, Embase, Scopus, Global Index Medicus, and CABI Global Health. Primary outcomes included the prevalence and types of HRQoL instruments adopted. A meta‐analysis of pooled HRQoL scores was performed to examine the impact of cardiac surgery. Results Thirty‐eight studies comprising 12,397 patients from seven countries were identified. Most studies were conducted in Iran (21, 55%) or India (7, 18%); only one study (2.6%) originated from a LIC (Rwanda). Generic HRQoL instruments predominated (28/41, 68%), most commonly the Short Form‐12/36 (SF‐12/36; 20, 49%) and the World Health Organization Quality of Life (WHOQOL) or WHOQOL Brief (WHOQOL‐BREF) (4, 9.8%). Cardiac surgery was associated with significant postoperative improvements in HRQoL, including physical (standardized mean difference [SMD]:1.17; 95% CI 0.83–1.51; p < 0.0001) and mental (0.78; 95% CI 0.47–1.09; p < 0.0001) component scores measured by SF‐12/36. Significant improvements were also observed across WHOQOL domains: physical (0.84; 95% CI 0.51–1.08; p < 0.0001), psychological (0.54; 95% CI 0.32–0.75; p < 0.0001), social (0.33; 95% CI 0.12–0.53; p = 0.002), and environmental (0.34; 95% CI 0.14–0.55; p = 0.001). Conclusions The use of validated and culturally appropriate HRQoL instruments is crucial for assessing patient‐centered outcomes in global cardiac surgery. Although significant improvements in HRQoL following cardiac surgery were observed in LI‐LMICs, fewer than 9% of LI‐LMICs were represented in the existing literature, highlighting a substantial gap in outcome assessment of global cardiac surgery.

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