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Yuan N, Boscardin C, Lisha NE, Dudley RA, Lin GA. Is Better Patient Knowledge Associated with Different Treatment Preferences? A Survey of Patients with Stable Coronary Artery Disease. Patient Prefer Adherence 2021; 15:119-126. [PMID: 33531798 PMCID: PMC7847412 DOI: 10.2147/ppa.s289398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/22/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In stable coronary artery disease (CAD), shared decision-making (SDM) is encouraged when deciding whether to pursue percutaneous coronary intervention (PCI) given similar cardiovascular outcomes between PCI and medical therapy. However, it remains unclear whether improving patient-provider communication and patient knowledge, the main tenets of SDM, changes patient preferences or the treatment chosen. We explored the relationships between patient-provider communication, patient knowledge, patient preferences, and the treatment received. METHODS We surveyed stable CAD patients referred for elective cardiac catheterization at seven hospitals from 6/2016 to 9/2018. Surveys assessed patient-provider communication, medical knowledge, and preferences for treatment and decision-making. We verified treatments received by chart review. We used linear and logistic regression to examine relationships between patient-provider communication and knowledge, knowledge and preference, and preference and treatment received. RESULTS Eighty-seven patients completed the survey. More discussion of the benefits and risks of both medical therapy and PCI associated with higher patient knowledge scores (β=0.28, p<0.01). Patient knowledge level was not associated with preference for PCI (OR=0.78, 95% CI 0.57-1.03, p=0.09). Black patients had more than four times the odds of preferring medical therapy to PCI (OR=4.49, 1.22-18.45, p=0.03). Patients preferring medical therapy were not significantly less likely to receive PCI (OR=0.67, 0.16-2.52, p=0.57). CONCLUSIONS While communicating the risks of PCI may improve patient knowledge, this knowledge may not affect patient treatment preferences. Rather, other factors such as race may be significantly more influential on a patient's treatment preferences. Furthermore, patient preferences are still not well reflected in the treatment received. Improving shared decision-making in stable CAD therefore may require not only increasing patient education but also better understanding and including a patient's background and pre-existing beliefs.
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Affiliation(s)
- Neal Yuan
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Correspondence: Neal Yuan Smidt Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Davis 1015, Los Angeles, CA90048, USA Email
| | - Christy Boscardin
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Nadra E Lisha
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - R Adams Dudley
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Grace A Lin
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
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2
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Astin F, Stephenson J, Probyn J, Holt J, Marshall K, Conway D. Cardiologists' and patients' views about the informed consent process and their understanding of the anticipated treatment benefits of coronary angioplasty: A survey study. Eur J Cardiovasc Nurs 2019; 19:260-268. [PMID: 31775522 DOI: 10.1177/1474515119879050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Percutaneous coronary intervention is a common revascularisation technique. Serious complications are uncommon, but death is one of them. Seeking informed consent in advance of percutaneous coronary intervention is mandatory. Research shows that percutaneous coronary intervention patients have inaccurate perceptions of risks, benefits and alternative treatments. AIM To assess cardiologists' and patients' views about the informed consent process and anticipated treatment benefits. METHODS Two cross-sectional, anonymous surveys were distributed in England: an electronic version to a sample of cardiologists and a paper-based version to patients recruited from 10 centres. RESULTS A sample of 118 cardiologists and 326 patients completed the surveys. Cardiologists and patients shared similar views on the purpose of informed consent; however, over 40% of patients and over a third of cardiologists agreed with statements that patients do not understand, or remember, the information given to them. Patients placed less value than cardiologists on the consent process and over 60% agreed that patients depended on their doctor to make the decision for them. Patients' and cardiologists' views on the benefits of percutaneous coronary intervention were significantly different; notably, 60% of patients mistakenly believed that percutaneous coronary intervention was curative. CONCLUSIONS The percutaneous coronary intervention informed consent process requires improvement to ensure that patients are more involved and accurately understand treatment benefits to make an informed decision. Redesign of the patient pathway is recommended to allow protected time for health professionals to engage in discussions using evidence-based approaches such as 'teach back' and decision support which improve patient comprehension.
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Affiliation(s)
- Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield, UK.,Research and Development, Huddersfield Royal Infirmary, UK
| | - John Stephenson
- Centre for Applied Research in Health, University of Huddersfield, UK
| | - Joy Probyn
- School of Health and Society, University of Salford, UK
| | - Janet Holt
- School of Healthcare, University of Leeds, UK
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3
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Curtis DA, Sadowsky SJ. How should we communicate implant treatment risk to a patient? J Am Dent Assoc 2019; 150:481-483. [DOI: 10.1016/j.adaj.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 11/16/2022]
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4
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Goff SL, Mazor KM, Ting HH, Kleppel R, Rothberg MB. How cardiologists present the benefits of percutaneous coronary interventions to patients with stable angina: a qualitative analysis. JAMA Intern Med 2014; 174:1614-21. [PMID: 25156523 PMCID: PMC4553927 DOI: 10.1001/jamainternmed.2014.3328] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Patients with stable coronary artery disease (CAD) attribute greater benefit to percutaneous coronary interventions (PCI) than indicated in clinical trials. Little is known about how cardiologists' presentation of the benefits and risks may influence patients' perceptions. OBJECTIVES To broadly describe the content of discussions between patients and cardiologists regarding angiogram and PCI for stable CAD, and to describe elements that may affect patients' understanding. DESIGN, SETTING, AND PARTICIPANTS Qualitative content analysis of encounters between cardiologists and patients with stable CAD who participated in the Verilogue Point-of-Practice Database between March 1, 2008, and August 31, 2012. Transcripts in which angiogram and PCI were discussed were retrieved from the database. Patients were aged 44 to 88 years (median, 64 years); 25% were women; 50% reported symptoms of angina; and 6% were taking more than 1 medication to treat angina. MAIN OUTCOMES AND MEASURES Results of conventional and directed qualitative content analysis. RESULTS Forty encounters were analyzed. Five major categories and subcategories of factors that may affect patients' understanding of benefit were identified: (1) rationale for recommending angiogram and PCI (eg, stress test results, symptoms, and cardiologist's preferences); (2) discussion of benefits (eg, accurate discussion of benefit [5%], explicitly overstated benefit [13%], and implicitly overstated benefit [35%]); (3) discussion of risks (eg, minimization of risk); (4) cardiologist's communication style (eg, humor, teach-back, message framing, and failure to respond to patient questions); and (5) patient and family member contributions to the discussion. CONCLUSIONS AND RELEVANCE Few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. The etiology of patient misunderstanding is likely multifactorial, but if future quantitative studies support the findings of this hypothesis-generating analysis, modifications to cardiologists' approach to describing the risks and benefits of the procedure may improve patient understanding.
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Affiliation(s)
- Sarah L Goff
- Department of Internal Medicine, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts2The Center for Quality of Care Research, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester
| | - Henry H Ting
- Division of Cardiovascular Diseases, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Reva Kleppel
- Department of Internal Medicine, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts
| | - Michael B Rothberg
- Department of Internal Medicine, Cleveland Clinic Medicine Institute, Cleveland, Ohio
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5
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Kureshi F, Jones PG, Buchanan DM, Abdallah MS, Spertus JA. Variation in patients' perceptions of elective percutaneous coronary intervention in stable coronary artery disease: cross sectional study. BMJ 2014; 349:g5309. [PMID: 25200209 PMCID: PMC4157615 DOI: 10.1136/bmj.g5309] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the perceptions of patients with stable coronary artery disease of the urgency and benefits of elective percutaneous coronary intervention and to examine how they vary across centers and by providers. DESIGN Cross sectional study. SETTING 10 US academic and community hospitals performing percutaneous coronary interventions between 2009 and 2011. PARTICIPANTS 991 patients with stable coronary artery disease undergoing elective percutaneous coronary intervention. MAIN OUTCOME MEASURES Patients' perceptions of the urgency and benefits of percutaneous coronary intervention, assessed by interview. Multilevel hierarchical logistic regression models examined the variation in patients' understanding across centers and operators after adjusting for patient characteristics, using median odds ratios. RESULTS The most common reported benefits from percutaneous coronary intervention were to extend life (90%, n=892; site range 80-97%) and to prevent future heart attacks (88%, n=872; site range 79-97%). Although nearly two thirds of patients (n=661) reported improvement of symptoms as a benefit of percutaneous coronary intervention (site range 52-87%), only 1% (n=9) identified this as the only benefit. Substantial variability was noted in the ways informed consent was obtained at each site. After adjusting for patient and operator characteristics, the median odds ratios showed significant variation in patients' perceptions of percutaneous coronary intervention across sites (range 1.4-3.1) but not across operators within a site. CONCLUSION Patients have a poor understanding of the benefits of elective percutaneous coronary intervention, with significant variation across sites. No sites had a high proportion of patients accurately understanding the benefits. Coupled with the wide variability in the ways in which hospitals obtain informed consent, these findings suggest that hospital level interventions into the structure and processes of obtaining informed consent for percutaneous coronary intervention might improve patient comprehension and understanding.
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Affiliation(s)
- Faraz Kureshi
- Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA University of Missouri- Kansas City, Kansas City, MO, USA
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA
| | - Donna M Buchanan
- Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA University of Missouri- Kansas City, Kansas City, MO, USA
| | - Mouin S Abdallah
- Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA University of Missouri- Kansas City, Kansas City, MO, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA University of Missouri- Kansas City, Kansas City, MO, USA
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6
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Pollock A, Jones DS. Coronary artery disease and the contours of pharmaceuticalization. Soc Sci Med 2014; 131:221-7. [PMID: 24985787 DOI: 10.1016/j.socscimed.2014.06.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/25/2014] [Accepted: 06/23/2014] [Indexed: 01/09/2023]
Abstract
Coronary artery disease (CAD) has dominated mortality for most of the past century, not just in Europe and North America but worldwide. Treatments for CAD, both pharmaceutical and surgical, have become leading sectors of the healthcare economy. This paper focuses on the therapeutic landscape for CAD in the United States. We hope to add texture to the broader conversation of pharmaceuticalization explored in this issue by situating pharmaceutical therapies as just one element in the broader therapeutic terrain, alongside cardiac surgery and interventional cardiology. Patients with CAD must navigate a therapeutic landscape with three intersecting paths: lifestyle change, pharmaceuticals, and surgery. While pharmaceuticals are often seen as a quick fix, a way of avoiding more difficult lifestyle changes, it is surgery and angioplasty that promise patients the quickest fix of all. There also is another option, often overlooked by analysts but popular among physicians and patients: inaction. The U.S. context is often critiqued as a site of excessive treatment with respect to both drugs and procedures, and yet there is deep stratification within it--over-treatment in many populations and under-treatment in others. People who experience the serious risks of CAD do so in a racialized terrain of durable preoccupations with difference and unequal access to care. While the pharmaceuticalization literature disproportionately attends to lifestyle drugs, which some observers consider to be medically inappropriate or unnecessary, CAD does remain the leading cause of death. Thus, the stakes are high. Examination of the pharmaceuticalization of CAD in light of surgical treatments and racial disparities offers a window into the pervasiveness and persuasiveness of pharmaceuticals in an increasingly consumer-driven medicine, as well as the limits of their appeal and their reach.
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Affiliation(s)
- Anne Pollock
- Georgia Tech, Skiles Building Room 360, Atlanta, GA 30332, USA.
| | - David S Jones
- Harvard University, Science Center 371, 1 Oxford St., Cambridge, MA 02138, USA.
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7
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Dempster M, Donnelly M. A Comparative Analysis of the SF-12 and the SF-36 among Ischaemic Heart Disease Patients. J Health Psychol 2012; 6:707-11. [PMID: 22049472 DOI: 10.1177/135910530100600608] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper investigated whether the SF-12 could replace the SF-36 in the measurement of health status among ischaemic heart disease patients. The SF-36 and SF-12 were administered to 105 cardiac patients. The SF-36 summary scores were strongly correlated and similar to the SF-12 summary scores. Also, the SF-12 scores were as powerful as the SF-36 summary scores in discriminating between subgroups of patients categorized according to their self-reported health status or angina classification. It is suggested that when there is a need to collect routine information about cardiac patients' general physical and mental health, the SF-12 is preferable to the SF-36 because of its brevity and acceptability to patients.
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Affiliation(s)
- M Dempster
- Queen's University Belfast, Northern Ireland
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8
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Blankenship JC, Marshall JJ, Pinto DS, Lange RA, Bates ER, Holper EM, Grines CL, Chambers CE. Effect of percutaneous coronary intervention on quality of life: A consensus statement from the society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv 2012; 81:243-59. [DOI: 10.1002/ccd.24376] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 02/12/2012] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Duane S. Pinto
- Beth Israel Deaconess Medical Center; Boston; Massachusetts
| | - Richard A. Lange
- University of Texas Health Science Center at San Antonio; San Antonio; Texas
| | - Eric R. Bates
- University of Michigan Hospitals and Health Centers; Ann Arbor; Michigan
| | | | - Cindy L. Grines
- Detroit Medical Center Cardiovascular Institute; Detroit; Michigan
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9
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Blankenship JC. Progress toward doing the right thing. JACC Cardiovasc Interv 2012; 5:236-8. [PMID: 22326194 DOI: 10.1016/j.jcin.2012.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 01/10/2012] [Indexed: 10/14/2022]
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10
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Holmes-Rovner M, Kelly-Blake K, Dwamena F, Dontje K, Henry RC, Olomu A, Rovner DR, Rothert ML. Shared Decision Making Guidance Reminders in Practice (SDM-GRIP). PATIENT EDUCATION AND COUNSELING 2011; 85:219-224. [PMID: 21282030 DOI: 10.1016/j.pec.2010.12.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 12/08/2010] [Accepted: 12/31/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Develop a system of practice tools and procedures to prompt shared decision making in primary care. SDM-GRIP (Shared Decision Making Guidance Reminders in Practice) was developed for suspected stable coronary artery disease (CAD), prior to the percutaneous coronary intervention (PCI) decision. METHODS Program evaluation of SDM-GRIP components: Grand Rounds, provider training (communication skills and clinical evidence), decision aid (DA), patient group visit, encounter decision guide (EDG), SDM provider visit. RESULTS Participation-Physician training=73% (21/29); patient group visits=25% of patients with diagnosis of CAD contacted (43/168). SDM visits=16% (27/168). Among SDM visit pairs, 82% of responding providers reported using the EDG in SDM encounters. Patients valued the SDM-GRIP program, and wanted to discuss comparative effectiveness information with a cardiologist. SDM visits were routinely reimbursed. CONCLUSION Program elements were well received and logistically feasible. However, recruitment to an extra educational group visit was low. Future implementation will move SDM-GRIP to the point of routine ordering of non-emergent stress tests to retain pre-decision timing of PCI and to improve coordination of care, with SDM tools available across primary care and cardiology. PRACTICE IMPLICATIONS Guidance prompts and provider training appear feasible. Implementation at stress testing requires further investigation.
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Affiliation(s)
- Margaret Holmes-Rovner
- Center for Ethics and Humanities in the Life Sciences, C203 East Fee, Michigan State University College of Human Medicine, East Lansing, MI 48824-1316, USA.
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11
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Chandrasekharan DP, Taggart DP. Informed consent for interventions in stable coronary artery disease: problems, etiologies, and solutions. Eur J Cardiothorac Surg 2011; 39:912-7. [DOI: 10.1016/j.ejcts.2010.08.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/10/2010] [Accepted: 08/16/2010] [Indexed: 11/27/2022] Open
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12
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Clay MA, Campbell RM, Strieper M, Frias PA, Stevens M, Mahle WT. Long-term risk of fatal malignancy following pediatric radiofrequency ablation. Am J Cardiol 2008; 102:913-5. [PMID: 18805121 DOI: 10.1016/j.amjcard.2008.05.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 05/10/2008] [Accepted: 05/10/2008] [Indexed: 11/26/2022]
Abstract
Children undergoing radiofrequency ablation (RFA) are believed to be at increased risk of developing malignancy caused by radiation, although the magnitude of this risk is incompletely understood. We previously reported a strategy to reduce radiation exposure during pediatric RFA. In a cohort of 15 subjects (median age 12 years, range 9 to 17), radiation was measured using dosimeters at 5 sites. The risk of malignancy using measured radiation absorbed dose was calculated. International Council for Radiation Protection 60 risk estimates were applied to calculate absorbed organ doses. Median duration of combined biplane fluoroscopy was 14.4 minutes. Of the 5 dosimeter locations, the right scapular location had the highest median radiation exposure (43 mGy). Incorporating data from the 5 dosimeters, the risk model calculated that the organ with the greatest absorbed dose and at greatest risk of malignancy was the lung, followed by bone marrow, then breast. Thyroid and ovary exposures were negligible. The increased lifetime risk of fatal malignancy was 0.02% per single RFA procedure. In conclusion, with appropriate measures to reduce radiation exposure, the increased risk of malignancy after a single RFA procedure in children is low. These data should be of help counseling families and will contribute to analysis of the relative risk reduction benefits of such novel imaging approaches as a magnetic resonance imaging-based catheterization laboratory.
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13
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Expected treatment benefits of percutaneous transluminal coronary angioplasty: the patient’s perspective. Int J Cardiovasc Imaging 2008; 24:567-75. [DOI: 10.1007/s10554-008-9297-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
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14
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Spertus JA, Salisbury AC, Jones PG, Conaway DG, Thompson RC. Predictors of Quality-of-Life Benefit After Percutaneous Coronary Intervention. Circulation 2004; 110:3789-94. [PMID: 15596563 DOI: 10.1161/01.cir.0000150392.70749.c7] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Improving patients’ quality of life is a primary indication for percutaneous coronary intervention (PCI), yet little is known about patient characteristics associated with greater quality-of-life improvement from the procedure. This study was conducted to identify patient characteristics associated with quality-of-life benefit after PCI.
Methods and Results—
A consecutive series of 1518 patients undergoing PCI in nonacute myocardial infarction settings were prospectively enrolled into an observational study documenting their postprocedural health status. We examined univariate and multivariable associations between baseline patient characteristics and quality of life 1 year after the procedure using the disease-specific Seattle Angina Questionnaire (SAQ) to quantify the impact of patients’ coronary disease on their quality of life. Baseline angina frequency and physical function were the strongest predictors of quality-of-life improvement 1 year after PCI. In comparing patients without angina to those experiencing monthly, weekly, and daily angina, the quality-of-life improvements (mean±SEM) were 21.4±2.1, 30.7±2.2, and 34.6±2.6 points greater (
P
<0.001). Patients with mild, moderate, and severe physical limitation improved 13.8±1.9, 20.0±2.1, and 13.5±3.5 points more than those with minimal baseline physical limitation (
P
<0.001). These findings were maintained in multivariable models correcting for baseline differences in demographic, clinical, disease-severity, and health-status variables.
Conclusions—
Preprocedural angina frequency is the most important prognostic indicator of quality-of-life improvement after PCI. Although substantial quality-of-life benefits are attained in most patients with preprocedural angina, more careful consideration of the potential benefits and risks of the procedure are needed in asymptomatic patients.
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Affiliation(s)
- John A Spertus
- University of Missouri-Kansas City, and Mid-America Heart Institute of Saint Luke's Hospital, USA.
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15
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Dempster M, Donnelly M, O'Loughlin C. The validity of the MacNew Quality of Life in heart disease questionnaire. Health Qual Life Outcomes 2004; 2:6. [PMID: 14738566 PMCID: PMC333433 DOI: 10.1186/1477-7525-2-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2003] [Accepted: 01/22/2004] [Indexed: 11/17/2022] Open
Abstract
Background A previous review suggested that the MacNew Quality of Life Questionnaire was the most appropriate disease-specific measure of health-related quality of life among people with ischaemic heart disease. However, there is ambiguity about the allocation of items to the three factors underlying the MacNew and the factor structure has not been confirmed previously among the people in the UK. Methods The MacNew Questionnaire and the SF-36 were administered to 117 newly admitted patients to a tertiary referral centre in Northern Ireland. All patients had been diagnosed with ischaemic heart disease. Results A confirmatory factor analysis was conducted on the factor structure of the MacNew and the model was found to be an inadequate fit of the data. A quantitative and qualitative analysis of the items suggested that a five factor solution was more appropriate and this was validated by confirmatory factor analysis. This new structure also displayed strong evidence of concurrent validity when compared to the SF-36. Conclusion We recommend that researchers should submit scores obtained from items on the MacNew to secondary analyses after being grouped according to the factor structure proposed in this paper, in order to explore further the most appropriate grouping of items.
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Affiliation(s)
- Martin Dempster
- School of Psychology, Queen's University, David Keir Building, 18–30 Malone Road Belfast, UK
| | - Michael Donnelly
- Department of Epidemiology & Public Health, Queen's University Belfast, UK
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16
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Dempster M, Donnelly M, Fitzsimons D. Generic, Disease-Specific and Individualised Approaches to Measuring Health-Related Quality of Life Among People With Heart Disease - A Comparative Analysis. Psychol Health 2002. [DOI: 10.1080/0887044022000004939] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Lindsay GM, Smith LN, Hanlon P, Wheatley DJ. Coronary artery disease patients' perception of their health and expectations of benefit following coronary artery bypass grafting. J Adv Nurs 2000; 32:1412-21. [PMID: 11136409 DOI: 10.1046/j.1365-2648.2000.01621.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This prospective descriptive study has analysed 214 patient interviews before and 1 year after coronary artery bypass grafting (CABG). The preoperative interview explored issues related to the impact of coronary artery disease upon health and expectations of benefit from the patients' perspective. The postoperative interview examined patients' accounts of the experience of operation and its impact on their health. A thematic analysis of the interview data was undertaken. The main factors relating to health status preoperatively were described in terms of 'dependency' on others and medication, and 'impending doom' of some major life threatening event. Benefits to health postoperatively were viewed in terms of 'removal of a death sentence' and 'freedom of choice'. Expectations of benefit from operation were varied and included 'freedom and independence', 'hope, chance and uncertainty' and 'addition of years to life and life to years'. Undergoing the operation was described by themes of the 'enormity of the experience' and 'the importance of lay support'. These findings provide a greater understanding of the 'lived experience' of both coronary artery disease and undergoing coronary artery bypass grafting. Unrealistic expectations of the benefits of CABG highlights the need for improvement in the way patients are informed about risks and benefits of interventions. In addition, the views and insights suggest that CABG operation is regarded as a significant major life event; thus more information, advice and counselling might help support patients before, during and after surgery.
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Affiliation(s)
- G M Lindsay
- Nursing and Midwifery School, University of Glasgow, Glasgow, Scotland.
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