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Association between appropriateness of coronary revascularization and quality of life in patients with stable ischemic heart disease.

Wijeysundera HC, Qiu F, Fefer P, Bennell MC, Austin PC, Ko DT - BMC Cardiovasc Disord (2014)

Bottom Line: The appropriateness for coronary revascularization was determined at the time of coronary angiography.On average, patients improved in most QOL domains, regardless of treatment strategy and appropriateness score.In patients with appropriate indications, revascularized patients had greater improvements in both generic (0.073; 95% CI 0.003-0.144; p-value 0.04) and disease-specific indices, including angina stability (14.6; 95% CI 0.85-28.3; p-value 0.04), physical limitation (9.3; 95% CI 0.71-17.8; p-value 0.03) and disease perception (12.7; 95% CI4.3-21.1; p-value 0.003) compared to medically treated patients.

View Article: PubMed Central - PubMed

Affiliation: Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. harindra.wijeysundera@sunnybrook.ca.

ABSTRACT

Background: The relationship between appropriateness score, treatment strategy and quality of life (QOL) among patients with stable ischemic heart disease (SIHD) is not known. In this prospective cohort study, we evaluated changes in generic and cardiac-specific quality of life in patients with documented SIHD, comparing patients with revascularization versus those with medical therapy alone, stratified by their appropriateness scores.

Methods: Consecutive patients with SIHD undergoing elective coronary angiogram from November 1st 2008 to December 1st 2009 completed the Seattle Angina Questionnaire (SAQ) and EQ-5D at the time of procedure and at 1 year. The appropriateness for coronary revascularization was determined at the time of coronary angiography.

Results: Our final cohort consisted of 425 patients, 69.4% of whom underwent revascularization. In the overall cohort, 272 (64.0%) had appropriate indications for revascularization, while 57 (13.4%) had inappropriate indications and 96 (22.6%) had uncertain indications. On average, patients improved in most QOL domains, regardless of treatment strategy and appropriateness score. In patients with appropriate indications, revascularized patients had greater improvements in both generic (0.073; 95% CI 0.003-0.144; p-value 0.04) and disease-specific indices, including angina stability (14.6; 95% CI 0.85-28.3; p-value 0.04), physical limitation (9.3; 95% CI 0.71-17.8; p-value 0.03) and disease perception (12.7; 95% CI4.3-21.1; p-value 0.003) compared to medically treated patients. However, patients with uncertain and inappropriate indications also had improvements in physical limitation and disease perception with revascularization compared to medical therapy.

Conclusions: Patients who had appropriate revascularization derived the greatest improvement in QOL compared with medical therapy.

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Changes in quality of life from baseline to 1 year. a-f: Changes in quality of life from baseline to 1 year are shown for patients categorized by treatment strategy and appropriateness category. P-values are based on per patient changes over time. For angina frequency (Figure 1a), higher scores represent less frequent angina.
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Fig1: Changes in quality of life from baseline to 1 year. a-f: Changes in quality of life from baseline to 1 year are shown for patients categorized by treatment strategy and appropriateness category. P-values are based on per patient changes over time. For angina frequency (Figure 1a), higher scores represent less frequent angina.

Mentions: Summary results for our primary analysis on patients with complete data are shown on Figure 1a-f. As is apparent, most quality of life indices had either statistically significant improvements or remained constant over the 1 year, regardless of appropriateness indication or treatment strategy. Indeed, we did not find a gradient between the appropriate, uncertain or inappropriate criteria. The exception was in patients treated medically who had inappropriate indications for revascularization; these patients had a significant worsening in their mean physical limitation scores over the 1 year (Figure 1c). Angina frequency and angina stability improved significantly for all patients, except those who had inappropriate indications and were treated medically (Figure 1a and 1b respectively). Disease perception improved significantly over the course of the 1-year follow-up in all groups (Figure 1d). Treatment satisfaction only improved significantly for patients with appropriate indications who were revascularized. In (Additional file 1: Table S3), we compared the proportion of patients who had substantial improvements (>20 point) over the 1-year of follow-up in the SAQ sub-scales. Patients who were revascularized had a higher proportion of patients with substantial improvements in angina frequency (33.9% vs 15.4%; p < 0.001), physical limitation (20% vs 5.4%; p < 0.001) and disease perception 31.9% vs 20% p = 0.012). However, across the appropriate use criteria, the only difference was in physical limitation (18.0% for appropriate vs 5.3% inappropriate p = 0.052).Figure 1


Association between appropriateness of coronary revascularization and quality of life in patients with stable ischemic heart disease.

Wijeysundera HC, Qiu F, Fefer P, Bennell MC, Austin PC, Ko DT - BMC Cardiovasc Disord (2014)

Changes in quality of life from baseline to 1 year. a-f: Changes in quality of life from baseline to 1 year are shown for patients categorized by treatment strategy and appropriateness category. P-values are based on per patient changes over time. For angina frequency (Figure 1a), higher scores represent less frequent angina.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4195906&req=5

Fig1: Changes in quality of life from baseline to 1 year. a-f: Changes in quality of life from baseline to 1 year are shown for patients categorized by treatment strategy and appropriateness category. P-values are based on per patient changes over time. For angina frequency (Figure 1a), higher scores represent less frequent angina.
Mentions: Summary results for our primary analysis on patients with complete data are shown on Figure 1a-f. As is apparent, most quality of life indices had either statistically significant improvements or remained constant over the 1 year, regardless of appropriateness indication or treatment strategy. Indeed, we did not find a gradient between the appropriate, uncertain or inappropriate criteria. The exception was in patients treated medically who had inappropriate indications for revascularization; these patients had a significant worsening in their mean physical limitation scores over the 1 year (Figure 1c). Angina frequency and angina stability improved significantly for all patients, except those who had inappropriate indications and were treated medically (Figure 1a and 1b respectively). Disease perception improved significantly over the course of the 1-year follow-up in all groups (Figure 1d). Treatment satisfaction only improved significantly for patients with appropriate indications who were revascularized. In (Additional file 1: Table S3), we compared the proportion of patients who had substantial improvements (>20 point) over the 1-year of follow-up in the SAQ sub-scales. Patients who were revascularized had a higher proportion of patients with substantial improvements in angina frequency (33.9% vs 15.4%; p < 0.001), physical limitation (20% vs 5.4%; p < 0.001) and disease perception 31.9% vs 20% p = 0.012). However, across the appropriate use criteria, the only difference was in physical limitation (18.0% for appropriate vs 5.3% inappropriate p = 0.052).Figure 1

Bottom Line: The appropriateness for coronary revascularization was determined at the time of coronary angiography.On average, patients improved in most QOL domains, regardless of treatment strategy and appropriateness score.In patients with appropriate indications, revascularized patients had greater improvements in both generic (0.073; 95% CI 0.003-0.144; p-value 0.04) and disease-specific indices, including angina stability (14.6; 95% CI 0.85-28.3; p-value 0.04), physical limitation (9.3; 95% CI 0.71-17.8; p-value 0.03) and disease perception (12.7; 95% CI4.3-21.1; p-value 0.003) compared to medically treated patients.

View Article: PubMed Central - PubMed

Affiliation: Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. harindra.wijeysundera@sunnybrook.ca.

ABSTRACT

Background: The relationship between appropriateness score, treatment strategy and quality of life (QOL) among patients with stable ischemic heart disease (SIHD) is not known. In this prospective cohort study, we evaluated changes in generic and cardiac-specific quality of life in patients with documented SIHD, comparing patients with revascularization versus those with medical therapy alone, stratified by their appropriateness scores.

Methods: Consecutive patients with SIHD undergoing elective coronary angiogram from November 1st 2008 to December 1st 2009 completed the Seattle Angina Questionnaire (SAQ) and EQ-5D at the time of procedure and at 1 year. The appropriateness for coronary revascularization was determined at the time of coronary angiography.

Results: Our final cohort consisted of 425 patients, 69.4% of whom underwent revascularization. In the overall cohort, 272 (64.0%) had appropriate indications for revascularization, while 57 (13.4%) had inappropriate indications and 96 (22.6%) had uncertain indications. On average, patients improved in most QOL domains, regardless of treatment strategy and appropriateness score. In patients with appropriate indications, revascularized patients had greater improvements in both generic (0.073; 95% CI 0.003-0.144; p-value 0.04) and disease-specific indices, including angina stability (14.6; 95% CI 0.85-28.3; p-value 0.04), physical limitation (9.3; 95% CI 0.71-17.8; p-value 0.03) and disease perception (12.7; 95% CI4.3-21.1; p-value 0.003) compared to medically treated patients. However, patients with uncertain and inappropriate indications also had improvements in physical limitation and disease perception with revascularization compared to medical therapy.

Conclusions: Patients who had appropriate revascularization derived the greatest improvement in QOL compared with medical therapy.

Show MeSH
Related in: MedlinePlus