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Kontoangelos K, Soulis D, Soulaidopoulos S, Antoniou CK, Tsiori S, Papageorgiou C, Martinaki S, Mourikis I, Tsioufis K, Papageorgiou C, Katsi V. Health Related Quality of Life and Cardiovascular Risk Factors. Behav Med 2024; 50:186-194. [PMID: 37224009 DOI: 10.1080/08964289.2023.2202847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/26/2023]
Abstract
Cardiovascular diseases (CVD) is associated with deteriorating of quality of life (QOL) and exercise capacity (EC) but less is known on how EC interplays with QOL. The present study explores the relationship between quality of life and cardiovascular risk factors in people who present in cardiology clinics. A total of 153 adult presentations completed the SF-36 Health Survey and provided data for hypertension, diabetes mellitus, smoking, obesity, hyperlipidemia and history of coronary heart disease. Physical capacity was assessed by treadmill test. were correlated with the scores of the psychometric questionnaires. Participants with longer duration on treadmill exercise score higher on the scale of physical functioning. The study found that treadmill exercise intensity and duration were associated with improved scores in dimensions of the physical component summary and the physical functioning of SF-36, respectively. The presence of cardiovascular risk factors is related to a decreased quality of life. Patients with cardiovascular diseases should undergo particularly detailed analysis of the quality of life along with specific mental factors such as depersonalization and posttraumatic stress disorder.
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Affiliation(s)
- Konstantinos Kontoangelos
- 1st Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
- University Mental Health Neurosciences and Precision Medicine Research Institute "Costas Stefanis", Athens, Greece
| | - Dimitris Soulis
- 1st Department of Cardiology, "Hippokration" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Stergios Soulaidopoulos
- 1st Department of Cardiology, "Hippokration" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Christos Konstantinos Antoniou
- 1st Department of Cardiology, "Hippokration" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Sofia Tsiori
- 1st Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
| | - Christos Papageorgiou
- University Mental Health Neurosciences and Precision Medicine Research Institute "Costas Stefanis", Athens, Greece
| | - Sofia Martinaki
- 1st Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
| | - Iraklis Mourikis
- 1st Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, "Hippokration" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Charalabos Papageorgiou
- University Mental Health Neurosciences and Precision Medicine Research Institute "Costas Stefanis", Athens, Greece
| | - Vasiliki Katsi
- 1st Department of Cardiology, "Hippokration" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
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Scierka LE, Peri-Okonny PA, Romain G, Cleman J, Spertus JA, Fitridge R, Secemsky E, Patel MR, Gosch KL, Mena-Hurtado C, Smolderen KG. Psychosocial and socioeconomic factors are most predictive of health status in patients with claudication. J Vasc Surg 2024; 79:1473-1482.e5. [PMID: 38266885 PMCID: PMC11180544 DOI: 10.1016/j.jvs.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND As a key treatment goal for patients with symptomatic peripheral artery disease (PAD), improving health status has also become an important end point for clinical trials and performance-based care. An understanding of patient factors associated with 1-year PAD health status is lacking in patients with PAD. METHODS The health status of 1073 consecutive patients with symptomatic PAD in the international multicenter PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry was measured at baseline and 1 year with the Peripheral Artery Questionnaire (PAQ). The association of 47 patient characteristics with 1-year PAQ scores was assessed using a random forest algorithm. Variables of clinical significance were retained and included in a hierarchical multivariable linear regression model predicting 1-year PAQ summary scores. RESULTS The mean age of patients was 67.7 ± 9.3 years, and 37% were female. Variables with the highest importance ranking in predicting 1-year PAQ summary score were baseline PAQ summary score, Patient Health Questionnaire-8 depression score, Generalized Anxiety Disorder-2 anxiety score, new onset symptom presentation, insurance status, current or prior diagnosis of depression, low social support, initial invasive treatment, duration of symptoms, and race. The addition of 19 clinical variables in an extended model marginally improved the explained variance in 1-year health status (from R2 0.312 to 0.335). CONCLUSIONS Patients' 1-year PAD-specific health status, as measured by the PAQ, can be predicted from 10 mostly psychosocial and socioeconomic patient characteristics including depression, anxiety, insurance status, social support, and symptoms. These characteristics should be validated and tested in other PAD cohorts so that this model can inform risk adjustment and prediction of PAD health status in comparative effectiveness research and performance-based care.
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Affiliation(s)
- Lindsey E Scierka
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT
| | - Poghni A Peri-Okonny
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT
| | - Gaelle Romain
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT
| | - Jacob Cleman
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO; Departments of Biomedical and Health Informatics and Internal Medicine, Section of Cardiovascular Disease, University of Missouri-Kansas City, Kansas City, MO
| | - Robert Fitridge
- Vascular Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Eric Secemsky
- Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT
| | - Kim G Smolderen
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiology, Department of Internal Medicine, Yale University, New Haven, CT; Department of Psychiatry, Section of Psychology, Yale University, New Haven, CT.
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Nogueira-Garcia B, Vilela M, Oliveira C, Caldeira D, Martins AM, Nobre Menezes M. A Narrative Review of Revascularization in Chronic Coronary Syndrome/Disease: Concepts and Misconceptions. J Pers Med 2024; 14:506. [PMID: 38793088 PMCID: PMC11122013 DOI: 10.3390/jpm14050506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Ischemic heart disease represents a significant global burden of morbidity and mortality. While revascularization strategies are well defined in acute settings, there are uncertainties regarding chronic coronary artery disease treatment. Recent trials have raised doubts about the necessity of revascularization for "stable", chronic coronary syndromes or disease, leading to a shift towards a more conservative approach. However, the issue remains far from settled. In this narrative review, we offer a summary of the most pertinent evidence regarding revascularization for chronic coronary disease, while reflecting on less-often-discussed details of major clinical trials. The cumulative evidence available indicates that there can be a prognostic benefit from revascularization in chronic coronary syndrome patients, provided there is significant ischemia, as demonstrated by either imaging or coronary physiology. Trials that have effectively met this criterion consistently demonstrate a reduction in rates of spontaneous myocardial infarction, which holds both prognostic and clinical significance. The prognostic benefit of revascularization in patients with heart failure with reduced ejection fraction remains especially problematic, with a single contemporary trial favouring surgical revascularization. The very recent publication of a trial focused on revascularizing non-flow-limiting "vulnerable" plaques adds further complexity to the field. The ongoing debates surrounding revascularization in chronic coronary syndromes emphasize the importance of personalized strategies. Revascularization, added to the foundational pillar of medical therapy, should be considered, taking into account symptoms, patient preferences, coronary anatomy and physiology, ischemia tests and intra-coronary imaging.
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Affiliation(s)
- Beatriz Nogueira-Garcia
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - Marta Vilela
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
| | - Catarina Oliveira
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
| | - Daniel Caldeira
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, 1049-001 Lisbon, Portugal
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, 1049-001 Lisbon, Portugal
- Faculdade de Medicina, Centro de Estudos de Medicina Baseada na Evidência (CEMBE), 1649-028 Lisbon, Portugal
| | - Ana Margarida Martins
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
| | - Miguel Nobre Menezes
- Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (B.N.-G.); (M.V.); (C.O.); (D.C.); (A.M.M.)
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, 1049-001 Lisbon, Portugal
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Sun YL, Yao YL, Jia MJ, Sun YY, Li HL, Ruan XF, Wang XL. Evaluation of the efficacy and safety of Suxiao Jiuxin Pill in the treatment of stable angina: A randomized, double-blind, placebo-controlled, multi-center clinical trial. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:116959. [PMID: 37487965 DOI: 10.1016/j.jep.2023.116959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/22/2023] [Accepted: 07/21/2023] [Indexed: 07/26/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Suxiao Jiuxin Pill (SJP) has been used for treating chronic stable angina (SA) for more than 40 years in China. SJP is composed of two Chinese herbs and has the effect of activating blood and promoting qi, according to traditional Chinese medicine (TCM) theory. AIM OF THE STUDY The study aims to determine the effects of adjunct SJP on conventional therapy in patients with SA which provides a complementary choice and its evidence for clinical medication for treating SA. MATERIALS AND METHODS Participants with SA were recruited and randomized 1:1 to either the SJP group or the control group for 24 weeks. Both groups received conventional treatment according to local tertiary hospital protocols, and the participants received additional SJP (composed of Ligusticum wallichii and Borneol) or placebo in treatment and control groups respectively. The primary outcome was the curative efficacy rate at week 4. Secondary outcomes are the curative efficacy rate, the total score of angina pectoris symptoms, CCS Angina Classification improvement, Seattle Angina Questionnaire (SAQ) score, TCM syndrome scores (TCMSS), and the curative efficacy rate of TCMSS. Adverse events and adverse drug reactions were observed and recorded for safety analysis. RESULTS A total of 324 participants with SA from 13 hospitals in China were enrolled in this trial. Compared with the control group, the curative efficacy rate of SA, the curative efficacy rate of TCMSS significantly increased, and the total score of angina pectoris symptoms and TCMSS significantly reduced in the SJP group at week 4, 12, and 24, accompanied by the statistically significant improvement in the curative efficacy rate based on CCS grade reduction (all P < 0.05). Furthermore, the SAQ score (physical limitation, angina stability, and treatment satisfaction) was evaluated as the quality of life significantly improved after treatment (P < 0.05). The medication compliance, concomitant medication, and rates of adverse events were similar between the two groups (P > 0.05). CONCLUSION The present prospective, multicenter, randomized, double-blind, placebo-controlled, clinical trial confirms that adjunct SJP to conventional treatment increased the curative efficacy and life quality of SA patients with no significant adverse drug reactions during the clinical application. CLINICAL TRIAL REGISTRATION (ID, ChiCTR1900021876, URL = http://www.chictr.org.cn/showproj.aspx?proj=34955).
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Affiliation(s)
- Yuan-Long Sun
- Cardiovascular Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yi-Li Yao
- Cardiovascular Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Mei-Jun Jia
- Cardiovascular Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yuan-Yuan Sun
- Cardiovascular Disease Drug Research Committee, China Association of Traditional Chinese Medicine, China
| | - He-Lin Li
- Beijing Yaohai Ningkang Pharmaceutical Technology Co., LTD, China
| | - Xiao-Fen Ruan
- Cardiovascular Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Xiao-Long Wang
- Cardiovascular Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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Siriyotha S, Pattanaprateep O, Srimahachota S, Sansanayudh N, Thakkinstian A, Limpijankit T. Factors associated with health-related quality of life in patients undergoing percutaneous coronary intervention: Thai PCI registry. Front Cardiovasc Med 2023; 10:1260993. [PMID: 38028486 PMCID: PMC10663305 DOI: 10.3389/fcvm.2023.1260993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) has been shown to improve health-related quality of life (HRQoL) in patients with coronary artery disease (CAD). The objectives of this study were to assess the changes in HRQoL and factors influencing these changes in CAD patients after undergoing PCI. Methods Data from a nationwide PCI registry across 39 hospitals in Thailand were collected in 2018-2019, including baseline characteristics, comorbid diseases, angiographic CAD severity, procedural details, and type of health insurance. HRQoL, as measured by utility scores, was determined in all patients using the Thai version of EQ-5D-5l at admission, discharge, and 6 and 12 months after discharge. The effects of time after PCI procedure and various factors on mean utility scores were assessed using a mixed-effect linear regression model. Results A total of 19,701 patients were included in the analysis; they had a mean age of 64.2 ± 11.7 years and were predominantly (69.1%) male. Following PCI, the mean utility scores increased from 66.6 ± 19.6 at admission to 81.9 ± 13.8 at discharge, and remained stable at 6 and 12 months (86.1 ± 12.3 and 88.0 ± 11.7, respectively). After adjusting for potential confounding variables, several factors were found to be independently associated with improved HRQoL, including angiographic success, male gender, overweight status, dyslipidemia, and radial access. Six other factors were associated with less improved HRQoLs, including cardiogenic shock/IABP support, old age, CKD, clinical presentation (STEMI and NSTEMI), prior cerebrovascular disease, and heart failure. There were no associations of CAD severity and procedural details with HRQoL. No differences were found related to type of health insurance, except that patients who were uninsured or self-pay tended to have less improvement in HRQoL. Conclusion HRQoL improved significantly after PCI in these subjects, as observed through 1 year of follow-up. Identifying the factors influencing these improvements may assist clinicians in tailoring patient interventions to optimise quality of life after PCI.
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Affiliation(s)
- Sukanya Siriyotha
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphot Srimahachota
- Cardiac Center and Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Nakarin Sansanayudh
- Cardiology Unit, Department of Internal Medicine, Pharmongkutklao Hospital, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thosaphol Limpijankit
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Wester M, Koll F, Luedde M, Langer C, Resch M, Luchner A, Müller K, Zeman F, Koller M, Maier LS, Sossalla S. Effects of percutaneous coronary intervention on dyspnea in stable coronary artery disease. Clin Res Cardiol 2023; 112:1194-1203. [PMID: 36100700 PMCID: PMC10449717 DOI: 10.1007/s00392-022-02107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/06/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dyspnea is a frequent symptom in patients with stable coronary artery disease (CAD) and is recognized as a possible angina equivalent. OBJECTIVES This study was to assess the impact of percutaneous coronary intervention (PCI) on dyspnea, quality of life, and angina pectoris in patients with stable CAD. METHODS The prospective, multi-center PLA-pCi-EBO-pilot trial included 144 patients with symptomatic stable CAD and successful PCI. The prespecified endpoints angina pectoris (Seattle Angina Questionnaire-SAQ) and dyspnea (NYHA scale) were assessed 6 months after PCI. Predictors for symptomatic improvement were assessed with uni- and multivariable logistic regression analyses. RESULTS Patients with concomitant dyspnea had worse SAQ physical limitation scores at baseline (49.5 ± 21.0 vs 58.9 ± 22.0, p = 0.013) but showed no difference for angina frequency or quality of life. Overall, symptomatic burden of angina pectoris and dyspnea was alleviated by PCI. However, patients with concomitant dyspnea had markedly worse scores for physical limitation (78.9 ± 25.0 vs 94.3 ± 10.6, p < 0.001), angina frequency (77.9 ± 22.8 vs 91.1 ± 12.4, p < 0.001), and quality of life (69.4 ± 24.1 vs 82.5 ± 14.4, p < 0.001) after PCI. The prevalence of dyspnea (NYHA class ≥ 2) declined from 73% before PCI to 54%. Of 95 initially dyspneic patients, 57 (60%) improved at least one NYHA class 6 months after PCI. In a multivariable logistic regression analysis, "atypical angina pectoris" was associated with improved NYHA class, whereas "diabetes mellitus" had a negative association. CONCLUSION PCI effectively reduced dyspnea, which is a frequent and demanding symptom in patients with CAD. The German Clinical Trials Register registration number is DRKS0001752 ( www.drks.de ).
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Affiliation(s)
- Michael Wester
- Department of Internal Medicine II, University Heart Centre Regensburg, University Medical Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Franziska Koll
- Department of Internal Medicine II, University Heart Centre Regensburg, University Medical Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Mark Luedde
- Kardiologische Gemeinschaftspraxis Bremerhaven, Bremerhaven, Germany
| | - Christoph Langer
- Kardiologisch-Angiologische Praxis, Heart Centre Bremen, Bremen, Germany
| | - Markus Resch
- Department of Internal Medicine I, St. Josef Hospital, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Karolina Müller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Michael Koller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Heart Centre Regensburg, University Medical Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Heart Centre Regensburg, University Medical Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Tin BT, Tat Bang H, Thu TTA, Anh NTM, Vu VH, Tap NV. Quality of Life in Patients With Unstable Angina Before and After Percutaneous Coronary Intervention: A Single-Center Pilot Study Using the European Quality of Life 5-Dimension 5-Level (EQ-5D-5L) Questionnaire. Cureus 2023; 15:e45886. [PMID: 37885559 PMCID: PMC10599217 DOI: 10.7759/cureus.45886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/28/2023] Open
Abstract
Background Unstable angina (UA) has a negative impact on patients' quality of life. Percutaneous coronary intervention (PCI) is a commonly recommended treatment that exhibits positive therapeutic effects and enhances quality of life. This study aimed to compare the alterations in quality of life and related factors before and after PCI in UA patients. Methods A longitudinal follow-up study was conducted on 48 patients with UA before and one month after undergoing PCI. The European Quality of Life (EuroQol) 5-Dimension 5-Level (EQ-5D-5L) scale was utilized to measure the quality of life of patients. Results The study revealed a significant improvement in the quality of life score after one month of coronary artery intervention compared to the pre-intervention stage: the quality of life score before the intervention was 0.73 ± 0.32, whereas it increased to 0.89 ± 0.20 after one month (p<0.001). Sex, occupation, and troponin T were associated with changes in quality of life one month after the coronary artery intervention. Conclusion The pilot study demonstrated a notable enhancement in the quality of life among patients with UA following coronary intervention. Additionally, sex, occupation, and troponin T were identified as factors associated with this improvement.
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Affiliation(s)
- Bui Thanh Tin
- Preventive Medicine Department, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Ho Tat Bang
- Thoracic and Vascular Department, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
- Health Organization and Management Department, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Tran Thi Anh Thu
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
- Health Communication Department, Medical Center of Binh Thanh District, Ho Chi Minh City, VNM
| | - Nguyen Thi My Anh
- Faculty of Nursing - Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Vu Hoang Vu
- Interventional Cardiology Department, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
- Internal Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Nguyen Van Tap
- Faculty of Medical Management, Nguyen Tat Thanh University, Ho Chi Minh City, VNM
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Leong DP, Cirne F, Aghel N, Baro Vila RC, Cavalli GD, Ellis PM, Healey JS, Whitlock R, Khalaf D, Mian H, Jolly SS, Mehta SR, Dent S. Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2023; 5:415-430. [PMID: 37614581 PMCID: PMC10443114 DOI: 10.1016/j.jaccao.2023.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 08/25/2023] Open
Abstract
Invasive cardiac interventions are recommended to treat ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. These recommendations are based on randomized controlled trials that historically included few individuals with active, advanced malignancies. Advanced malignancies represent a significant competing risk for mortality, and there is limited evidence to inform the risks and benefits of invasive cardiac interventions in affected patients. We review the benefit conferred by invasive cardiac interventions; the periprocedural considerations; the contemporary survival expectations of patients across several types of active, advanced malignancy; and the literature on cardiovascular interventions in these populations. Our objective is to develop a rational framework to guide clinical recommendations on the use of invasive cardiac interventions in patients with active, advanced cancer.
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Affiliation(s)
- Darryl P. Leong
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Filipe Cirne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nazanin Aghel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Peter M. Ellis
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S. Healey
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard Whitlock
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dina Khalaf
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Sanjit S. Jolly
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shamir R. Mehta
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina, USA
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Tsoulou V, Vasilopoulos G, Kapadochos T, Pavlatou N, Kalogianni A, Toulia G, Dousis E, Panoutsopoulos G, Kourakos M, Polikandrioti M. Quality of Life in Patients Undergoing Percutaneous Coronary Intervention. Clin Pract 2023; 13:621-637. [PMID: 37218808 DOI: 10.3390/clinpract13030057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) is a non-surgical invasive procedure to treat coronary artery occlusion. The quality of life (QoL) is a way to measure the impact of illness and additionally its treatments to traditional measures of clinical outcomes. PURPOSE The aim of the present study was to explore the levels of QoL pre-PCI, 6 and 12 months after PCI, as well as the factors associated with the QoL pre-PCI. METHODS In the present study, 100 patients undergoing PCI were enrolled. Data were collected through the completion of the SF-36 Health Survey (SF-36), which included participants' characteristics. The statistical significance level was p < 0.05. RESULTS Patients had moderate levels of QoL at baseline, with a median general health score of 45 (IQR: 30-65). A gradual statistically significant increase in scores was observed in all subcategories of the patients' QoL at 6 and 12 months after PCI (p < 0.001). A greater increase in scores was observed in physical functioning, physical role, emotional role and social functionality. In terms of the pre-PCI phase, it was found that physical functionality was statistically significantly associated with educational level (p = 0.005), occupation (p = 0.026) and whether the patients had children (p = 0.041). The physical and emotional role was significantly associated with gender (p = 0.046 and p = 0.040) and educational level (p = 0.030 and p = 0.001). Energy-fatigue was significantly associated with gender (p = 0.001), age (p = 0.028), marital status (p = 0.001), educational level (p = 0.001), whether the patients had children (p= 0.012) and other diseases (p = 0.001). Emotional well-being was significantly associated with family history of coronary artery disease (p = 0.011) and the frequency of physical exercise (p = 0.001). Social functioning was significantly associated with gender (p = 0.033), marital status (p = 0.034) and educational level (p = 0.002). Pain was not found to be significantly associated with patients' demographics. General health was significantly associated with gender (p = 0.003), age (p = 0.043), educational level (p = 0.001), other diseases (p = 0.005) and the frequency of physical exercise (p = 0.001). CONCLUSION Information about the QoL of PCI and its determinants is important to define an effective and comprehensive care plan.
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Affiliation(s)
- Vasiliki Tsoulou
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | | | | | - Niki Pavlatou
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | | | - Georgia Toulia
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | - Evangellos Dousis
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | - George Panoutsopoulos
- Department of Nutritional Science and Dietetics, University of Peloponnese, 24100 Kalamata, Greece
| | - Michael Kourakos
- Department of Nursing, University of Ioannina, 45110 Ioannina, Greece
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Hamilton GW, Yeoh J, Dinh D, Reid CM, Yudi MB, Freeman M, Brennan A, Stub D, Oqueli E, Sebastian M, Duffy SJ, Horrigan M, Farouque O, Ajani A, Clark DJ. Trends and Real-World Safety of Patients Undergoing Percutaneous Coronary Intervention for Symptomatic Stable Ischaemic Heart Disease in Australia. Heart Lung Circ 2022; 31:1619-1629. [PMID: 36856290 DOI: 10.1016/j.hlc.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) in stable ischaemic heart disease (SIHD) has not been shown to improve prognosis but can alleviate symptoms and improve quality of life. Appropriately selected patients with symptoms refractory to medical therapy therefore stand to benefit, provided safety is proven. METHODS Consecutive patients undergoing PCI for SIHD between 2005-2018 in a prospective registry were included. Yearly comparisons evaluated trends, and a sub-analysis was performed comparing proximal left anterior descending artery (prox-LAD) to other-than-proximal LAD (non-pLAD) PCI. Outcomes included peri-procedural characteristics, in-hospital and 30-day event rates including MACE, and 5-year National Death Index (NDI) linked mortality. RESULTS There were 9,421 procedures included. Over time, patients were increasingly co-morbid and had higher rates of AHA/ACC class B2/C lesions, ostial stenoses, bifurcation lesions, and chronic total occlusions (all p-for-trend ≤0.001). Over 14 years, major bleeding reduced (1.05% in 2005/06 vs 0.29% in 2017/18, p-for-trend <0.001), while other in-hospital and 30-day event rates were stably low. There were only seven (0.07%) in hospital deaths and 5-year mortality was 10.3%. No differences were found in outcomes between patients who underwent prox-LAD compared to non-pLAD PCI. Major independent predictors of NDI linked all-cause mortality included an eGFR <30 mL/min/1.73 m2 (HR 4.06, 95% CI 3.26-5.06), chronic obstructive pulmonary disease (COPD) (HR 2.25, 95% CI 1.89-2.67) and LVEF <30% (HR 2.13, 95% CI 1.57-2.89). CONCLUSIONS Although patient and procedural complexity increased over time, a high degree of procedural success and safety was maintained, including in those undergoing prox-LAD PCI. These real-world data can enhance shared decision making discussions regarding whether PCI should be pursued in patients with symptomatic SIHD refractory to medical therapy.
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Affiliation(s)
- Garry W Hamilton
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Vic, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia
| | - Dion Stub
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Base Hospital, Ballarat, Vic, Australia
| | - Martin Sebastian
- Department of Cardiology, University Hospital Geelong, Vic, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Andrew Ajani
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia.
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Nakano S, Kohsaka S, Chikamori T, Fukushima K, Kobayashi Y, Kozuma K, Manabe S, Matsuo H, Nakamura M, Ohno T, Sawano M, Toda K, Ueda Y, Yokoi H, Gatate Y, Kasai T, Kawase Y, Matsumoto N, Mori H, Nakazato R, Niimi N, Saito Y, Shintani A, Watanabe I, Watanabe Y, Ikari Y, Jinzaki M, Kosuge M, Nakajima K, Kimura T. JCS 2022 Guideline Focused Update on Diagnosis and Treatment in Patients With Stable Coronary Artery Disease. Circ J 2022; 86:882-915. [DOI: 10.1253/circj.cj-21-1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shintaro Nakano
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Kenji Fukushima
- Department of Radiology and Nuclear Medicine, Fukushima Medical University
| | | | - Ken Kozuma
- Cardiology, Teikyo University School of Medicine
| | - Susumu Manabe
- Cardiac Surgery, International University of Health and Welfare Mita Hospital
| | | | - Masato Nakamura
- Cardiovascular Medicine, Toho University Ohashi Medical Center
| | | | | | - Koichi Toda
- Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Hiroyoshi Yokoi
- Cardiovascular Center, International University of Health and Welfare Fukuoka Sanno Hospital
| | - Yodo Gatate
- Cardiology, Self-Defense Forces Central Hospital
| | | | | | | | - Hitoshi Mori
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Yuichi Saito
- Cardiovascular Medicine, Chiba University School of Medicine
| | - Ayumi Shintani
- Medical Statistics, Osaka City University Graduate School of Medicine
| | - Ippei Watanabe
- Cardiovascular Medicine, Toho University School of Medicine
| | | | - Yuji Ikari
- Cardiology, Tokai University School of Medicine
| | | | | | - Kenichi Nakajima
- Functional Imaging and Artificial Intelligence, Kanazawa University
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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12
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Patel KK, Patel FS, Bateman TM, Kennedy KF, Peri-Okonny PA, McGhie AI, Sperry BW, Shaw L, Carli MD, Thompson RC, Saeed IM, Jones PG, Spertus JA. Relationship Between Myocardial Perfusion Imaging Abnormalities on Positron Emission Tomography and Anginal Symptoms, Functional Status, and Quality of Life. Circ Cardiovasc Imaging 2022; 15:e013592. [PMID: 35167313 PMCID: PMC8869837 DOI: 10.1161/circimaging.121.013592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) identifies abnormalities that occur early in the ischemic cascade leading to angina. Our aim was to study the association between ischemic measures on positron emission tomography MPI and patients' health status; their symptoms, function, and quality of life. METHODS Health status was collected using the Seattle Angina Questionnaire (SAQ-7, 0-100, higher=better) and Rose Dyspnea Score (RDS) on 1515 outpatients with known or suspected coronary artery disease presenting for clinically indicated pharmacological 82Rb positron emission tomography MPI from July 2018 to July 2019. Adjusted multivariable ordinal regression models were used to assess the association between MPI findings of ischemia and the SAQ physical limitation, angina frequency, quality of life, summary score, and the RDS. RESULTS The mean SAQ and RDS scores of the cohort (mean age 71.7 years, 55% male, 37.6% prior myocardial infarction or revascularization) were 73.8±28.6 (physical limitation), 87.4±21.7 (angina frequency), 79.0±26.1 (quality of life), 81.3±19.0 (summary score), and 2±2 (RDS). No perfusion, flow or function abnormalities were significantly associated with SAQ angina frequency scores. Low left ventricular ejection fraction reserve (≤0%), low global and regional myocardial blood flow reserve (<2) were independently associated with worse SAQ Physical Limitation score, SAQ summary score, and RDS (30% to 57% greater odds; all P≤0.01), but reversible perfusion defects were not. CONCLUSIONS Impaired augmentation of left ventricular ejection fraction and myocardial blood flow with stress is associated with significant angina-associated functional limitation, health status, and dyspnea in patients who underwent positron emission tomography MPI, but not the frequency of their angina. Future studies should evaluate whether therapies that improve stress-induced abnormalities in systolic function and myocardial flow may improve patients' health status.
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Affiliation(s)
- Krishna K. Patel
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Timothy M. Bateman
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - Poghni A. Peri-Okonny
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - A. Iain McGhie
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Brett W. Sperry
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Leslee Shaw
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marcelo Di Carli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Randall C. Thompson
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Ibrahim M. Saeed
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - John A. Spertus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
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13
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Amin A, Rachmawaty R, Tahir T, Musmulyono M. Evaluation of quality of life-based on the length of use and the number of stents of post percutaneous coronary intervention (PCI) patients. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Coronary stent fracture in an octogenarian patient: from bad to worse. J Geriatr Cardiol 2021; 18:968-972. [PMID: 34908931 PMCID: PMC8648541 DOI: 10.11909/j.issn.1671-5411.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Flynn CR, Orkaby AR, Valsdottir LR, Kramer DB, Ho KK, Dodson JA, Yeh RW, Strom JB. Relation of the Number of Cardiovascular Conditions and Short-term Symptom Improvement After Percutaneous Coronary Intervention for Stable Angina Pectoris. Am J Cardiol 2021; 155:1-8. [PMID: 34281673 DOI: 10.1016/j.amjcard.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 01/09/2023]
Abstract
With aging of the population, cardiovascular conditions (CC) are increasingly common in individuals undergoing PCI for stable angina pectoris (AP). It is unknown if the overall burden of CCs associates with diminished symptom improvement after PCI for stable AP. We prospectively administered validated surveys assessing AP, dyspnea, and depression to patients undergoing PCI for stable AP at our institution, 2016-2018. The association of CC burden and symptoms at 30-days post-PCI was assessed via linear mixed effects models. Included individuals (N = 121; mean age 68 ± 10 years; response rate = 42%) were similar to non-included individuals. At baseline, greater CC burden was associated with worse dyspnea, depression, and physical limitations due to AP, but not AP frequency or quality of life. PCI was associated with small improvements in AP and dyspnea (p ≤ 0.001 for both), but not depression (p = 0.15). After multivariable adjustment, including for baseline symptoms, CC burden was associated with a greater improvement in AP physical limitations (p = 0.01) and depression (p = 0.002), albeit small, but not other symptom domains (all p ≥ 0.05). In patients undergoing PCI for stable AP, increasing CC burden was associated with worse dyspnea, depression, and AP physical limitations at baseline. An increasing number of CCs was associated with greater improvements, though small, in AP physical limitations and depression. In conclusion, the overall number of cardiovascular conditions should not be used to exclude patients from PCI for stable AP on the basis of an expectation of less symptom improvement.
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Affiliation(s)
- Christopher R Flynn
- Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Ariela R Orkaby
- Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System; Division of Aging, Brigham & Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Linda R Valsdottir
- Harvard Medical School, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Daniel B Kramer
- Harvard Medical School, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kalon K Ho
- Harvard Medical School, Boston, Massachusetts; Division of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John A Dodson
- New York University School of Medicine, New York, New York
| | - Robert W Yeh
- Harvard Medical School, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jordan B Strom
- Harvard Medical School, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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16
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Bibi S, Khan A, Nadeem A, Mushtaq S, Khan GM. Assessment of utility values and QALYs after primary PCI with DP-Xience and BP-Biomatrix stents. PLoS One 2021; 16:e0253290. [PMID: 34138969 PMCID: PMC8211164 DOI: 10.1371/journal.pone.0253290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention (PPCI) is the recommended treatment in ST elevated myocardial infarction (STEMI). The determination of Quality of life (QoL) for various options of coronary revascularization is important for establishment of a comprehensive care plan. Studies of QoL in interventional cardiology are scarce. Our study has compared utility scores and quality adjusted life year (QALY) of 2nd and 3rd generation drug eluting stents (DES). METHODS An observational cohort study was conducted to evaluate QoL and QALY using EQ-5D-5L questionnaire. Patients undergoing PPCI between July-Dec 2019 were evaluated after completion of one year of procedure. RESULTS Total 334 patients were evaluated, study population consisted of a greater number of males (87.13%) than females. Mean utility value was more in 3rd G Biomatrix stents; 0.829 ± 0.11 than 2nd G Xience stents; 0.794 ± 0.11 (p < 0.05). Visual analogue scale (VAS) value was also high in 3rd G DES (81.84 ± 8.29) as compared to 2nd G DES (77.81 ± 9.01); p< 0.05. A significant association was found between utility scores/VAS and age, DM, HTN, Current smoking, family history and CAD diagnosis. There was a gain of 0.035 QALY with the use of Biomatrix DES. CONCLUSION Health related quality of life (HRQOL) is a leading support in the decision making of therapeutic interventions. Our study has found that Biodegradable polymer (BP) Biomatrix DES are superior to the Durable polymer (DP) Xience DES having better QoL and QALY.
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Affiliation(s)
- Salma Bibi
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Asif Nadeem
- Armed Forces Institute of Cardiology-National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan
| | - Saima Mushtaq
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Islamia College University, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Roczniak J, Koziołek W, Piechocki M, Tokarek T, Surdacki A, Bartuś S, Chyrchel M. Comparison of Access Site-Related Complications and Quality of Life in Patients after Invasive Cardiology Procedures According to the Use of Radial, Femoral, or Brachial Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116151. [PMID: 34200250 PMCID: PMC8201254 DOI: 10.3390/ijerph18116151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 11/16/2022]
Abstract
The radial approach (RA) is the most common in invasive cardiology, but depending on the clinical situation, the femoral approach (FA) and brachial approach (BA) are also used. The BA is associated with the highest odds of complications so it is used mainly if a first-choice approach fails. The aim of the study was to assess clinical outcomes after invasive cardiology procedures stratified by the use of the RA, FA, and BA, with a focus on access site-related complications, quality of life (QoL), and patients' perspective. A total of 250 procedures (RA: 98; FA: 99; BA: 53) performed between 2013 and 2020 were retrospectively analyzed. Puncture site-related complications, vascular events, patient preferences, and QoL were assessed by the analysis of medical records and telephone follow-up using a proprietary questionnaire and the modified EQ-5D-3L questionnaire. Patients from the RA group received the smallest volume of contrast during a percutaneous coronary interventions (PCI) procedure (RA vs. FA vs. BA: 180 (150-240) mL vs. 200 (180-270) mL vs. 190 (100-200) mL, p = 0.045). The access site was changed most frequently in the procedures initiated from the RA (p < 0.04). Overall puncture site-related complications, especially local hematomas, occurred most commonly in the BA group (7.1, 14.1, and 24.5% for RA, FA, and BA, respectively, p = 0.01). During the index procedure, the access site was changed most frequently in procedures initiated from the RA (19.7, 8.5 and 0%, p = 0.04). The RA was indicated as an approach preferred by the patient for a hypothetical next procedure (87.9, 55.4, and 70.0% for subjects preferring the same approach out of patients who underwent a procedure by the RA, FA, and BA, respectively, p < 0.001). For the RA and FA, the prevalence of moderate or extreme access site-related problems in self-care decreased significantly (RA: p < 0.01, FA: p < 0.05) within 1 month after the index procedure (RA: 18.1, 4.2, and 1.4%; FA: 20.7, 11.1, and 9.6% periprocedurally, after 1 and 6 months, respectively). In contrast, for the BA these percentages were higher and a significant improvement (p < 0.05) was delayed until 6 months (54.6, 36.4, and 18.2% periprocedurally, after 1 and 6 months, respectively). In conclusion, compared to the BA and FA, the RA appears to be not only the safest, mainly due to the lowest risk of puncture site-related complications after coronary procedures but also represents a preferable approach from the patient's perspective. Although overall post-procedural QoL outcomes did not differ significantly according to the access site, nevertheless, the BA was associated with more frequent self-care problems whose improvement was delayed until more than one month after the index procedure.
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Affiliation(s)
- Jan Roczniak
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.R.); (W.K.); (M.P.)
| | - Wojciech Koziołek
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.R.); (W.K.); (M.P.)
| | - Marcin Piechocki
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.R.); (W.K.); (M.P.)
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Center for Intensive Care and Perioperative Medicine, Faculty of Medicine, Jagiellonian University Medical College, 30-901 Cracow, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland
- Correspondence: ; Tel.: +48-12-400-2250
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Is There Enough Evidence to Revascularize a Chronic Total Occlusion? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 25:55-56. [PMID: 33422412 DOI: 10.1016/j.carrev.2020.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022]
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19
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Qayyum S, Rossington JA, Chelliah R, John J, Davidson BJ, Oliver RM, Ngaage D, Loubani M, Johnson MJ, Hoye A. Prospective cohort study of elderly patients with coronary artery disease: impact of frailty on quality of life and outcome. Open Heart 2020; 7:openhrt-2020-001314. [PMID: 32989014 PMCID: PMC7523192 DOI: 10.1136/openhrt-2020-001314] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/19/2020] [Accepted: 07/21/2020] [Indexed: 11/22/2022] Open
Abstract
Background Elderly, frail patients are often excluded from clinical trials so there is lack of data regarding optimal management when they present with symptomatic coronary artery disease (CAD). Objective The aim of this observational study was to evaluate an unselected elderly population with CAD for the occurrence of frailty, and its association with quality of life (QoL) and clinical outcomes. Methods Consecutive patients aged ≥80 years presenting with CAD were prospectively assessed for frailty (Fried frailty phenotype (FFP), Edmonton frailty scale (EFS)), QoL (Short form survey (SF-12)) and comorbidity (Charlson Comorbidity Index (CCI)). Patients were re-assessed at 4 months to determine any change in frailty and QoL status as well as the clinical outcome. Results One hundred fifty consecutive patients with symptomatic CAD were recruited in the study. The mean age was 83.7±3.2 years, 99 (66.0%) were men. The clinical presentation was stable angina in 68 (45.3%), the remainder admitted with an acute coronary syndrome including 21 (14.0%) with ST-elevation myocardial infarction. Frailty was present in 28% and 26% by FFP and EFS, respectively, and was associated with a significantly higher CCI (7.5±2.4 in frail, 6.2±2.2 in prefrail, 5.9±1.6 in those without frailty, p=0.005). FFP was significantly related to the physical composite score for QoL, while EFS was significantly related to the mental composite score for QoL (p=0.003). Treatment was determined by the cardiologist: percutaneous coronary intervention in 51 (34%), coronary artery bypass graft surgery in 15 (10%) and medical therapy in 84 (56%). At 4 months, 14 (9.3%) had died. Frail participants had the lowest survival. Cardiovascular symptom status and the mental composite score of QoL significantly improved (52.7±11.5 at baseline vs 55.1±10.6 at follow-up, p=0.04). However, overall frailty status did not significantly change, nor the physical health composite score of QoL (37.2±11.0 at baseline vs 38.5±11.3 at follow-up, p=0.27). Conclusions In patients referred to hospital with CAD, frailty is associated with impaired QoL and a high coexistence of comorbidities. Following cardiac treatment, patients had improvement in cardiovascular symptoms and mental component of QoL.
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Affiliation(s)
- Shouaib Qayyum
- Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK .,Academic Cardiology, Castle Hill Hospital, Cottingham, UK
| | | | | | | | | | | | - Dumbor Ngaage
- Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Mahmoud Loubani
- Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Angela Hoye
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, United Kingdom
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Quality of Life Changes in Acute Coronary Syndromes Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186889. [PMID: 32967168 PMCID: PMC7558854 DOI: 10.3390/ijerph17186889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/08/2020] [Accepted: 09/19/2020] [Indexed: 12/26/2022]
Abstract
There is little up-to-date evidence about changes in quality of life following treatment for acute coronary syndrome (ACS) patients. The main aim of this review was to assess the changes in QoL in ACS patients after treatment. We undertook a systematic review and meta-analysis of quantitative studies. The search included studies that described the change of QoL of ACS patients after receiving treatment options such as percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical therapy (MT). We synthesized findings using content analysis and pooled the estimates using meta-analysis. We used the PRISMA guidelines to select and appraise the studies and report the findings. Twenty-nine (29) articles were included in the review. We found a significant improvement of QoL in ACS patients after receiving treatment. Particularly, the meta-analytic association found that the mean QoL of patients diagnosed with ACS was higher after receiving treatment compared to baseline (overall pooled mean difference = 31.88; 95% CI = 31.64–52.11, I2 = 98) with patients on PCI having slightly lower QoL gains (pooled mean difference = 30.22; 95% CI = 29.9–30.53, I2 = 0%) compared to those on CABG (pooled mean difference = 34.01; 95% CI = 33.66–34.37, I2 = 0%). The review confirmed that QoL of ACS patients improved after receiving treatment therapies although varied by the treatment options and patients’ preferences. This suggests the need to perform further study on the QoL, patient preferences and physicians’ decision to prescription of treatment options.
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21
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Wlodarczyk D, Zietalewicz U. How gender-specific are predictors of post-MI HRQoL? A longitudinal study. Health Qual Life Outcomes 2020; 18:202. [PMID: 32586341 PMCID: PMC7318476 DOI: 10.1186/s12955-020-01439-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/05/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Extant research shows that health-related quality of life (HRQoL) differs between female and male survivors of myocardial infarction (MI), but the reasons for this are not fully understood. We aimed to examine the predictors of HRQoL in female and male survivors during the first year after MI. Methods At timepoints 1 and 2, the sample comprised 222 MI survivors (59 women and 163 men; mean age 53.84 years, range 24–65) referred for in-patient cardiac rehabilitation. This number dropped to 140 participants (42 women and 98 men) at the third timepoint, approximately one year after the MI. We examined the gender differences in various predictors of physical and mental HRQoL: demographic factors (e.g., age, education, marital status), disease-related factors (pre- and post-MI), personality and coping with stress. Results Initially, both physical and mental HRQoL were lower in women than men, but the differences disappeared at timepoint 3. Stepwise regressions performed separately for men and women revealed that the factors shaping HRQoL were different in both genders; they also changed over time. Substantially fewer factors predicted physical HRQoL in women than in men. Trait anxiety seems to play a similarly negative role in both genders. Conclusions The psychosocial resources that influence HRQoL were different for women and men. There were also differences concerning predictors of HRQoL dimensions. Further studies with a different or broader range of predictors are needed, especially among women.
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Affiliation(s)
- Dorota Wlodarczyk
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, Warsaw, Poland
| | - Urszula Zietalewicz
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, Warsaw, Poland.
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22
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Rawal S, Sawant AC, Sridhar M, Chaudhry M, Sridhara S, Distler E, Challa S, Parone L, Yazdchi S, Rodriguez J, Daus K, Pershad A. Impact of Intravascular Brachytherapy on Patient-Reported Outcomes in Patients with Coronary Artery Disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1550-1554. [PMID: 32546383 DOI: 10.1016/j.carrev.2020.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intravascular brachytherapy (VBT) is an established treatment for the management of in-stent restenosis (ISR). However, whether VBT is associated with improved patient reported outcomes unknown. METHODS We evaluated 51 consecutive patients undergoing VBT in one or more coronary arteries from January 2018 to September 2019. Data on baseline characteristics, procedural outcomes and adverse events were obtained. All patients completed the Seattle Angina Questionnaire - 7 (SAQ-7) form before and after VBT at 1 month and 6 months. RESULTS The mean age was 69 ± 9 years and 29 (57%) of patients were males. Procedural success was 94.1%. The mean summary SAQ-7 score improved significantly (53.2 ± 21 vs. 83 ± 19, p < .001) at 30-days. The median Quality of Life (QoL) component of SAQ-7 score was 31.3 (Interquartile Range [IQR]: 18.8, 62.5) and improved to 82.5 (IQR: 62.5, 100), p < .001 at 30 days and 87.5 [IQR: 75, 100), p < .001 at last follow up. Likewise, the median angina frequency component of the SQL-7 score pre-VBT was 55 (IQR: 45, 80) and improved significantly to 90 (IQR: 60, 100) at 30-days, p < .001 and 100 [IQR: 68.8, 100], p = .02 at last follow up. Lastly, the median activity component of the SAQ-7 score improved from 83.3 (IQR: 60-100) to 100 (IQR: 83, 100), p = .01 at 30-days. Thus, results were evident as early as 1 month and sustained at median follow up of 17 months. CONCLUSION VBT is associated with improvement in patient reported outcome measures at short term and long term follow up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Kelly Daus
- University Medical Center, Phoenix, AZ, USA
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23
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Individualizing Revascularization Strategy for Diabetic Patients With Multivessel Coronary Disease. J Am Coll Cardiol 2020; 74:2074-2084. [PMID: 31623766 DOI: 10.1016/j.jacc.2019.07.083] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND In patients with diabetes and multivessel coronary artery disease (CAD), the FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial demonstrated that, on average, coronary artery bypass grafting (CABG) was superior to percutaneous coronary intervention (PCI) for major acute cardiovascular events (MACE) and angina reduction. Nonetheless, multivessel PCI remains a common revascularization strategy in the real world. OBJECTIVES To translate the results of FREEDOM to individual patients in clinical practice, risk models of the heterogeneity of treatment benefit were built. METHODS Using patient-level data from 1,900 FREEDOM patients, the authors developed models to predict 5-year MACE (all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke) and 1-year angina after CABG and PCI using baseline covariates and treatment interactions. Parsimonious models were created to support clinical use. The models were internally validated using bootstrap resampling, and the MACE model was externally validated in a large real-world registry. RESULTS The 5-year MACE occurred in 346 (18.2%) patients, and 310 (16.3%) had angina at 1 year. The MACE model included 8 variables and treatment interactions with smoking status (c = 0.67). External validation in stable CAD (c = 0.65) and ACS (c = 0.68) demonstrated comparable performance. The 6-variable angina model included a treatment interaction with SYNTAX score (c = 0.67). PCI was never superior to CABG, and CABG was superior to PCI for MACE in 54.5% of patients and in 100% of patients with history of smoking. CONCLUSIONS To help disseminate the results of FREEDOM, the authors created a personalized risk prediction tool for patients with diabetes and multivessel CAD that could be used in shared decision-making for CABG versus PCI by estimating each patient's personal outcomes with both treatments.
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24
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Spertus JA, Jones PG, Maron DJ, O'Brien SM, Reynolds HR, Rosenberg Y, Stone GW, Harrell FE, Boden WE, Weintraub WS, Baloch K, Mavromatis K, Diaz A, Gosselin G, Newman JD, Mavromichalis S, Alexander KP, Cohen DJ, Bangalore S, Hochman JS, Mark DB. Health-Status Outcomes with Invasive or Conservative Care in Coronary Disease. N Engl J Med 2020; 382:1408-1419. [PMID: 32227753 PMCID: PMC7261489 DOI: 10.1056/nejmoa1916370] [Citation(s) in RCA: 260] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
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Affiliation(s)
- John A Spertus
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Philip G Jones
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - David J Maron
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Sean M O'Brien
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Harmony R Reynolds
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Yves Rosenberg
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Gregg W Stone
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Frank E Harrell
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - William E Boden
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - William S Weintraub
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Khaula Baloch
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Kreton Mavromatis
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Ariel Diaz
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Gilbert Gosselin
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Jonathan D Newman
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Stavroula Mavromichalis
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Karen P Alexander
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - David J Cohen
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Sripal Bangalore
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Judith S Hochman
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
| | - Daniel B Mark
- From Saint Luke's Mid America Heart Institute Kansas City (J.A.S., P.G.J.) and the University of Missouri-Kansas City (J.A.S., P.G.J., D.J.C.), Kansas City; Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M.); Duke Clinical Research Institute and Duke University, Durham, NC (S.M.O., K.B., K.P.A., D.B.M.); New York University Grossman School of Medicine (H.R.R., J.D.N., S.M., S.B., J.S.H.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R.); the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville (F.E.H.); Veterans Affairs (VA) New England Healthcare System, Boston University School of Medicine, Boston (W.E.B.); MedStar Washington Hospital Center, Washington, DC (W.S.W.); Atlanta VA Healthcare System, Emory University School of Medicine, Atlanta (K.M.); and Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), University of Montreal, Campus Mauricie, Trois-Rivieres, QC (A.D.), and the Montreal Heart Institute, Montreal (G.G.) - both in Canada
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25
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Zheng X, Dreyer RP, Curtis JP, Liu S, Xu X, Bai X, Li X, Zhang H, Wang S, Masoudi FA, Spertus JA, Li J, Krumholz HM. Sex Differences in 1-Year Health Status Following Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction: Results From the China PEACE Prospective Study. J Am Heart Assoc 2020; 9:e014421. [PMID: 32131687 PMCID: PMC7335522 DOI: 10.1161/jaha.119.014421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Sex differences in health status outcomes after percutaneous coronary intervention among patients without acute myocardial infarction are not well described. Methods and Results A total of 2237 patients (33.4% women) without acute myocardial infarction undergoing percutaneous coronary intervention were enrolled from 39 Chinese tertiary hospitals in the PEACE (China Patient‐centered Evaluative Assessment of Cardiac Events) prospective percutaneous coronary intervention study. Data were collected immediately before and 1 year following percutaneous coronary intervention. Health status was measured using the disease‐specific Seattle Angina Questionnaire (SAQ) Angina Frequency and Quality of Life domains, as well as the SAQ Summary Score. Among the study population, women were older, more often single, had lower levels of education, and had a higher prevalence of cardiac risk factors such as hypertension and diabetes mellitus. Women had lower mean 1‐year SAQ Angina Frequency scores (mean±SD, 91.0±17.3 versus 93.9±13.3; P<0.01), SAQ Quality of Life scores (mean±SD, 67.3±23.0 versus 70.6±21.6; P<0.01), and SAQ Summary Scores (mean±SD, 81.6±13.8 versus 84.8±11.9; P<0.01), a difference of marginal clinical significance that persisted after multivariable adjustment. A slightly larger improvement in the SAQ Summary Score was observed in women as compared with men (20.9±22.6 versus 18.5±21.3; P=0.007) in unadjusted analysis. However, women were less likely to achieve clinically significant improvement in SAQ Angina Frequency (adjusted odds ratio, 0.67; 95% CI, 0.45–1.00) and SAQ Quality of Life (adjusted odds ratio, 0.73; 95% CI, 0.56–0.96) after adjustment. Conclusions There were no clinically significant differences in 1‐year health status outcomes and improvement in health status by sex among patients without acute myocardial infarction following percutaneous coronary intervention. However, female sex was associated with poorer 1‐year health status and a lower likelihood of experiencing clinically improvement in health status. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01624922.
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Affiliation(s)
- Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, National Center for Cardiovascular Diseases Beijing People's Republic of China
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
| | - Shuling Liu
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences Yale School of Medicine New Haven CT
| | - Xueke Bai
- National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, National Center for Cardiovascular Diseases Beijing People's Republic of China
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, National Center for Cardiovascular Diseases Beijing People's Republic of China
| | - Haibo Zhang
- National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, National Center for Cardiovascular Diseases Beijing People's Republic of China
| | - Siming Wang
- National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, National Center for Cardiovascular Diseases Beijing People's Republic of China
| | - Frederick A Masoudi
- Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO
| | - John A Spertus
- Department of Cardiovascular Outcomes Research Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City Kansas City MO
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, National Center for Cardiovascular Diseases Beijing People's Republic of China
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
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26
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Saxon JT, Grantham JA, Salisbury AC, Sapontis J, Lombardi WL, Karmpaliotis D, Moses J, Nicholson WJ, Tang Y, Cohen DJ, Spertus JA, Safley DM. Appropriate Use Criteria and Health Status Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN-CTO Registry. Circ Cardiovasc Interv 2020; 13:e008448. [PMID: 32069112 DOI: 10.1161/circinterventions.119.008448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American College of Cardiology/American Heart Association Appropriate Use Criteria were designed to aid clinical decision-making, yet their association with health status outcomes after chronic total occlusion percutaneous coronary intervention (PCI) is unknown. METHODS We analyzed 769 patients with baseline and 1-year health status data after chronic total occlusion PCI. Procedures were categorized as appropriate, may be appropriate, or rarely appropriate. Mean changes in patient-reported health status, assessed by the Seattle Angina Questionnaire (SAQ), were compared across appropriate use criteria categories from baseline to 1 year. Change in SAQ summary score was stratified as little to no benefit (≤10 points), intermediate (10-19 points), large (20-29 points), and very large (≥30 points). RESULTS The appropriate use criteria indication was appropriate in 573 patients (74.5%), may be appropriate in 191 (24.8%), and rarely appropriate in 5 (0.7%). Patients in the appropriate group reported greater improvement in SAQ summary scores (27.3±21.3 points) at 1 year compared with the may be appropriate (22.5±20.9; P=0.01). A similar pattern was noted for SAQ angina frequency (mean change 24.0±27.2 versus 18.7±25.6; P=0.02). The appropriate group had the highest proportion of very large improvements in SAQ summary scores (44.5% versus 33.3%; P=0.01). CONCLUSIONS Among patients undergoing chronic total occlusion PCI, the rate of rarely appropriate PCI was low. The rate of appropriate PCI was high and was associated with the greatest health status improvement at 1 year. A substantial proportion of patients in the may be appropriate group experienced meaningful health status benefits as well.
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Affiliation(s)
- John T Saxon
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | | | | | | | - Jeffery Moses
- Columbia University Medical Center/New York-Presbyterian Hospital (D.K., J.M.)
| | | | - Yuanyuan Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.)
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - David M Safley
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
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27
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Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41:407-477. [PMID: 31504439 DOI: 10.1093/eurheartj/ehz425] [Citation(s) in RCA: 3752] [Impact Index Per Article: 938.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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28
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Xin YG, Li JL, Cao X, Liu XJ. Efficacy and Safety of Different Antiplatelet Strategies in Survivors of Myocardial Infarction With Acute Coronary Syndrome. Clin Ther 2019; 41:2090-2101.e1. [PMID: 31500853 DOI: 10.1016/j.clinthera.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/03/2019] [Accepted: 08/15/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Many patients with acute coronary syndrome may experience recurrent myocardial infarction although they are receiving optional therapy, but they are still associated with poor clincial outcomes. The goal of this study was to assess different antiplatelet strategies in these patients. METHODS This retrospective trial compared ticagrelor (180-mg loading dose, 90-mg BID maintenance dose) and clopidogrel (300- to 600-mg loading dose, 150-mg daily maintenance dose) for the prevention of cardiovascular events in 1083 patients with acute coronary syndrome and recurrent myocardial infarction admitted to the hospital undergoing percutaneous coronary intervention. FINDINGS At the 24-month follow-up, a major adverse cardiovascular and cerebrovascular event (MACCE) occurred in 10.5% of patients receiving ticagrelor compared with 13.2% in the clopidogrel group (P = 0.023). Meanwhile, ticagrelor caused a higher rate of minor bleeding (18.1% vs 15.3%; P = 0.008). A survival analysis showed that ticagrelor decreased the incidence of MACCE (log-rank test, P < 0.001) and all-cause death (log-rank test, P = 0.001). The advantage of ticagrelor was also presented according to analysis of Seattle Angina Questionnaire scores. IMPLICATIONS In patients with recurrent myocardial infarction, the ticagrelor antiplatelet strategy significantly reduced the MACCE rate without increasing the risk of major bleeding, although patients did have a higher risk of minor bleeding.
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Affiliation(s)
- Yan-Guo Xin
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jun-Li Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofan Cao
- Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xiao-Jing Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Chengdu, China.
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29
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Zhang Z, Jones P, Weintraub WS, Mancini GBJ, Sedlis S, Maron DJ, Teo K, Hartigan P, Kostuk W, Berman D, Boden WE, Spertus JA. Predicting the Benefits of Percutaneous Coronary Intervention on 1-Year Angina and Quality of Life in Stable Ischemic Heart Disease: Risk Models From the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation). Circ Cardiovasc Qual Outcomes 2019; 11:e003971. [PMID: 29752388 DOI: 10.1161/circoutcomes.117.003971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 02/16/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is a therapy to reduce angina and improve quality of life in patients with stable ischemic heart disease. However, it is unclear whether the quality of life after PCI is more dependent on the PCI or other patient-related factors. To address this question, we created models to predict angina and quality of life 1 year after PCI and medical therapy. METHODS AND RESULTS Using data from the 2287 stable ischemic heart disease patients randomized in the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) to PCI plus optimal medical therapy (OMT) versus OMT alone, we built prediction models for 1-year Seattle Angina Questionnaire angina frequency, physical limitation, and quality of life scores, both as continuous outcomes and categorized by clinically desirable states, using multivariable techniques. Although most patients improved regardless of treatment, marked variability was observed in Seattle Angina Questionnaire scores 1 year after randomization. Adding PCI conferred a greater mean improvement (about 2 points) in Seattle Angina Questionnaire scores that were not affected by patient characteristics (P values for all interactions >0.05). The proportion of patients free of angina or having very good/excellent physical limitation (physical function) or quality of life at 1 year was 57%, 58%, 66% with PCI+OMT and 50%, 55%, 59% with OMT alone group, respectively. However, other characteristics, such as baseline symptoms, age, diabetes mellitus, and the magnitude of myocardium subtended by narrowed coronary arteries were as, or more, important than revascularization in predicting symptoms (partial R2=0.07 versus 0.29, 0.03 versus 0.22, and 0.05 versus 0.24 in the domain of angina frequency, physical limitation, and quality of life, respectively). There was modest/good discrimination of the models (C statistic=0.72-0.82) and excellent calibration (coefficients of determination for predicted versus observed deciles=0.83-0.97). CONCLUSIONS The health status outcomes of stable ischemic heart disease patients treated by OMT+PCI versus OMT alone can be predicted with modest accuracy. Angina and quality of life at 1 year is improved by PCI but is more strongly associated with other patient characteristics. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00007657.
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Affiliation(s)
- Zugui Zhang
- Christiana Care Health System, Newark, DE (Z.Z.)
| | - Philip Jones
- Mid-America Heart Institute/University of Missouri-Kansas City (P.J., J.A.S.)
| | | | | | - Steven Sedlis
- New York Veterans Affairs Medical Center and New York University (S.S.)
| | | | - Koon Teo
- McMaster University, Hamilton, ON, Canada (K.T.)
| | - Pamela Hartigan
- Cooperative Studies Program Coordinating Center, Veterans Affairs Connecticut Healthcare System, West Haven (P.H.)
| | | | | | - William E Boden
- Veterans Affairs New England Healthcare System, Massachusetts Veterans Epidemiology, Research, and Informatics Center, Boston (W.E.B.)
| | - John A Spertus
- Mid-America Heart Institute/University of Missouri-Kansas City (P.J., J.A.S.)
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Qintar M, Hirai T, Arnold SV, Sheehy J, Sapontis J, Jones P, Tang Y, Lombardi W, Karmpaliotis D, Moses J, Patterson C, Nicholson WJ, Cohen DJ, Spertus JA, Grantham JA, Salisbury AC. De-escalation of antianginal medications after successful chronic total occlusion percutaneous coronary intervention: Frequency and relationship with health status. Am Heart J 2019; 214:1-8. [PMID: 31152872 DOI: 10.1016/j.ahj.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can markedly reduce angina symptom burden, but many patients often remain on multiple antianginal medications (AAMs) after the procedure. It is unclear when, or if, AAMs can be de-escalated to prevent adverse effects or limit polypharmacy. We examined the association of de-escalation of AAMs after CTO PCI with long-term health status. METHODS In a 12-center registry of consecutive CTO PCI patients, health status was assessed at 6 months after successful CTO PCI with the Seattle Angina Questionnaire and the Rose Dyspnea Scale. Among patients with technical CTO PCI success, we examined the association of AAM de-escalation with 6-month health status using multivariable models adjusting for revascularization completeness and predicted risk of post-PCI angina (using a validated risk model). We also examined predictors and variability of AAMs de-escalation. RESULTS Of 669 patients with technical success of CTO PCI, AAMs were de-escalated in 276 (35.9%) patients at 1 month. Patients with AAM de-escalation reported similar angina and dyspnea rates at 6 months compared with those whose AAMs were reduced (any angina: 22.5% vs 20%, P = .43; any dyspnea: 51.8% vs 50.1%, P = .40). In a multivariable model adjusting for complete revascularization and predicted risk of post-PCI angina, de-escalation of AAMs at 1 month was not associated with an increased risk of angina, dyspnea, or worse health status at 6 months. CONCLUSIONS Among patients with successful CTO PCI, de-escalation of AAMs occurred in about one-third of patients at 1 month and was not associated with worse long-term health status.
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Sajobi TT, Wang M, Awosoga O, Santana M, Southern D, Liang Z, Galbraith D, Wilton SB, Quan H, Graham MM, James MT, Ghali WA, Knudtson ML, Norris C. Trajectories of Health-Related Quality of Life in Coronary Artery Disease. Circ Cardiovasc Qual Outcomes 2019; 11:e003661. [PMID: 29545392 DOI: 10.1161/circoutcomes.117.003661] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 01/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) assessment is an important health outcome for measuring the efficacy of treatments and interventions for coronary artery disease (CAD). HRQOL is known to improve over the first year after interventions for CAD, but there is limited knowledge of the changes in HRQOL beyond 1 year. We investigated heterogeneity in long-term trajectories of HRQOL in patients with CAD. METHODS AND RESULTS Data were obtained from 6226 patients identified from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease with at least 1-vessel CAD who underwent their first catheterization between 2006 and 2009. HRQOL was assessed using the Seattle Angina Questionnaire, a 19-item disease-specific measure of HRQOL for patients with CAD. Group-based trajectory analysis was used to identify various subgroups of Seattle Angina Questionnaire trajectories over time while adjusting for missing data through a longitudinal multiple imputation model. Multinomial logistic regression was used to identify the predictors of differences among the identified subgroups. Our analysis revealed significant improvements in HRQOL across all the 5 domains of Seattle Angina Questionnaire overtime for the whole data. Multitrajectory analyses revealed 4 HRQOL trajectory subgroups including high (25.1%), largely increased (32.3%), largely decreased (25.0%), and low (17.6%) trajectories. Age, sex, body mass index, diabetes mellitus, previous history of myocardial infarction, smoking, depression, anxiety, type of treatment received, and perceived social support were significant predictors of differences among these trajectory subgroups. CONCLUSIONS This study highlights variations in longitudinal trajectories of HRQOL in patients with CAD. Despite overall improvements in HRQOL, about a quarter of our cohort experienced a significant decline in their HRQOL over the 5-year period. Understanding these HRQOL trajectories may help personalize prognostic information, identify patients and HRQOL domains on which clinical interventions are most beneficial, and support treatment decisions for patients with CAD.
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Affiliation(s)
- Tolulope T Sajobi
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada.
| | - Meng Wang
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Oluwagbohunmi Awosoga
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Maria Santana
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Danielle Southern
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Zhiying Liang
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Diane Galbraith
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Stephen B Wilton
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Hude Quan
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Michelle M Graham
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Matthew T James
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - William A Ghali
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Merrill L Knudtson
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Colleen Norris
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
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Hattler B, Carr BM, Messenger J, Spertus J, Ebrahimi R, Bishawi M, Quin JA, Almassi GH, Collins JF, Kozora E, Grover FL, Shroyer ALW. Clinical and Angiographic Predictors of Patient-Reported Angina 1 Year After Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Qual Outcomes 2019; 12:e005119. [DOI: 10.1161/circoutcomes.118.005119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brack Hattler
- Rocky Mountain Regional VA Medical Center, Aurora, CO (B.H., F.L.G.)
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
| | - Brendan M. Carr
- Northport Veterans Affairs Medical Center, Northport, NY (B.M.C., M.B., A.L.W.S.)
| | - John Messenger
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
| | - John Spertus
- Saint Luke’s Mid America Heart Institute/University of Missouri at Kansas City, Kansas City, MO (J.S.)
| | - Ramin Ebrahimi
- Greater Los Angeles VA Medical Center, Los Angeles, CA (R.E.)
- University of California, Los Angeles (R.E.)
| | - Muath Bishawi
- Northport Veterans Affairs Medical Center, Northport, NY (B.M.C., M.B., A.L.W.S.)
- Duke University, Durham, NC (M.B.)
| | - Jacquelyn A. Quin
- VA Boston Healthcare System, West Roxbury, MA (J.A.Q.)
- Harvard Medical School, Boston, MA (J.A.Q.)
| | - G. Hossein Almassi
- Zablocki Veterans Affairs Medical Center, Milwaukee, WI (G.H.A.)
- Medical College of Wisconsin, Milwaukee (G.H.A.)
| | - Joseph F. Collins
- Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.)
| | - Elizabeth Kozora
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
- National Jewish Health, Denver, CO (E.K.)
| | - Frederick L. Grover
- Rocky Mountain Regional VA Medical Center, Aurora, CO (B.H., F.L.G.)
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
| | - A. Laurie W. Shroyer
- Northport Veterans Affairs Medical Center, Northport, NY (B.M.C., M.B., A.L.W.S.)
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Path analysis for key factors influencing long-term quality of life of patients following a percutaneous coronary intervention. Coron Artery Dis 2019; 30:339-345. [PMID: 30707110 DOI: 10.1097/mca.0000000000000712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This cross-sectional study aimed to investigate the long-term quality of life (QOL) influencing of patients following a percutaneous coronary intervention (PCI) as well as its influencing factors. PATIENTS AND METHODS From June 2013 to April 2014, 428 PCI patients were enrolled in this questionnaire survey. The demographic and clinical data, Social Support Rating Scale, Medical Coping Modes Questionnaire, Social Disability Screening Schedule, and Short Form 36 Health Status Questionnaire were collected. Statistical analyses for data and path analyses for influencing factors were then carried out. RESULTS PCI patients received considerable social support from family and society, and most PCI patients adopted negative coping styles (avoidance and acceptance-resignation). Approximately 70.3% of PCI patients had a serious functional defect, and 96.97% of patients had an average (79.91%) or better (17.06%) QOL. Multiple linear regression analysis showed that long-term QOL of PCI patients was correlated positively with social support and sleep quality, but correlated negatively with the acceptance-resignation coping style, social function defects, and number of adverse cardiac events. Path analysis further showed that social support, acceptance-resignation coping style, social function defects, number of adverse cardiac events, and sleep quality exerted important effects on long-term QOL of PCI patients in descending order. CONCLUSION Most PCI patients had an average medium-term or better long-term QOL. Social support, acceptance-resignation coping style, social function defects, number of adverse cardiac events, and sleep quality were key influencing factors.
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Lu Y, Zhang H, Wang Y, Zhou T, Welsh J, Liu J, Guan W, Li J, Li X, Zheng X, Spertus JA, Masoudi FA, Krumholz HM, Jiang L. Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction in China: Results From the China PEACE Prospective Study of Percutaneous Coronary Intervention. JAMA Netw Open 2018; 1:e185446. [PMID: 30646292 PMCID: PMC6324328 DOI: 10.1001/jamanetworkopen.2018.5446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Despite a rapid increase in percutaneous coronary intervention (PCI) procedures in China, little is known about patient-reported health status before and after PCI in patients without acute myocardial infarction (AMI). OBJECTIVE To describe self-perceived angina-specific health status prior to PCI and 1 year after the procedure in patients without AMI in China. DESIGN, SETTING, AND PARTICIPANTS The China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Prospective Study of PCI was a population-based, multicenter cohort study of a consecutive sample of 1611 patients without AMI undergoing elective PCI. Participants were enrolled from 40 hospitals in 18 provinces in China from December 2012 to August 2014. Participants were eligible if they underwent PCI for stable and unstable angina and did not have AMI. Participants were excluded if they died in hospital, withdrew from follow-up, or had missing data on self-reported health status at baseline or at 1 year after PCI. The date of the analysis was September 15, 2018. EXPOSURES Percutaneous coronary intervention for ischemic heart disease. MAIN OUTCOMES AND MEASURES Angina frequency and angina-related quality of life were assessed with the Seattle Angina Questionnaire (SAQ) immediately prior to PCI and 1 year after the procedure. Either (1) an increase in the SAQ Angina Frequency score of 10 or more points or (2) an increase in the SAQ Quality-of-Life score of 10 or more points was considered to represent clinically significant improvement. RESULTS Of 1611 patients, 520 (32.3%) were women; mean (SD) age was 61.3 (9.8) years. Among these patients, 443 (27.5%) had stable coronary artery disease and 1168 (72.5%) had unstable angina. One hundred fourteen of 443 patients undergoing PCI for stable coronary artery disease (25.7%) and 175 of 1168 undergoing PCI for unstable angina (15.0%) had no reported angina symptoms at the time of the procedure (SAQ Angina Frequency score = 100). Moreover, 18% of all patients (290) had minimal angina symptoms (SAQ Angina Frequency score >90) and, thus, no potential for substantial clinical improvement. Patients with smaller clinical improvements in angina symptom burden at 1 year following PCI had significantly higher baseline SAQ scores for all scales than patients with greater clinical improvement, but generally similar sociodemographic and procedural characteristics. CONCLUSIONS AND RELEVANCE In this study, 25.7% of patients undergoing PCI for stable coronary artery disease had no reported angina symptoms at the time of the procedure. Patients with smaller clinical improvements in angina symptom burden had higher baseline SAQ scores, which highlights the importance of ascertaining impairment from angina among patients without AMI prior to performing PCI.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Haibo Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Tianna Zhou
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut
| | - John Welsh
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut
| | - Jiamin Liu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - Wenchi Guan
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - John A. Spertus
- Health Outcomes Research, Saint Luke’s Mid America Heart Institute/University of Missouri-Kansas City, Kansas City
| | | | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
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Peri-Okonny PA, Patel KK, Jones PG, Breeding T, Gosch KL, Spertus JA, Arnold SV. Low Diastolic Blood Pressure Is Associated With Angina in Patients With Chronic Coronary Artery Disease. J Am Coll Cardiol 2018; 72:1227-1232. [PMID: 30190000 PMCID: PMC6309611 DOI: 10.1016/j.jacc.2018.05.075] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND In patients with coronary artery disease (CAD), low diastolic blood pressure (DBP) is associated with increased risk of myocardial infarction, but its association with angina is unknown. OBJECTIVES The goal of this study was to examine the association of low DBP and angina in patients with CAD. METHODS The study assessed the frequency of angina (measured by using the Seattle Angina Questionnaire-Angina Frequency score) according to DBP in patients with known CAD from 25 U.S. cardiology clinics. Hierarchical logistic regression was used to test the association between DBP and angina, with a spline term for DBP to assess nonlinearity. RESULTS Among 1,259 outpatients with CAD, 411 (33%) reported angina in the prior month, with higher rates in the lowest DBP quartile (40 to 64 mm Hg: 37%). In the unadjusted model, DBP was associated with angina with a J-shaped relationship (p = 0.017, p for nonlinearity = 0.027), with a progressive increase in odds of angina as DBP decreased below ∼70 to 80 mm Hg. This association remained significant after sequential adjustment for demographic characteristics (p = 0.002), comorbidities (p = 0.002), heart rate (p = 0.002), systolic blood pressure (p = 0.046), and antihypertensive antianginal medications (p = 0.045). CONCLUSIONS In patients with chronic CAD, there seemed to be an association between lower DBP and increased odds of angina. If validated, these findings suggest that clinicians should consider less aggressive blood pressure control in patients with CAD and angina.
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Affiliation(s)
- Poghni A Peri-Okonny
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
| | - Krishna K Patel
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Tracie Breeding
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
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Qintar M, Grantham JA, Sapontis J, Gosch KL, Lombardi W, Karmpaliotis D, Moses J, Salisbury AC, Cohen DJ, Spertus JA, Arnold SV. Dyspnea Among Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Intervention: Prevalence and Predictors of Improvement. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.003665. [PMID: 29237745 DOI: 10.1161/circoutcomes.117.003665] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dyspnea is a common angina equivalent that adversely affects quality of life, but its prevalence in patients with chronic total occlusions (CTOs) and predictors of its improvement after CTO percutaneous coronary intervention (PCI) are unknown. We examined the prevalence of dyspnea and predictors of its improvement among patients selected for CTO PCI. METHODS AND RESULTS In the OPEN CTO registry (Outcomes, Patient health status, and Efficiency iN Chronic Total Occlusion) of 12 US experienced centers, 987 patients undergoing CTO PCI (procedure success 82%) were assessed for dyspnea with the Rose Dyspnea Scale at baseline and 1 month after CTO PCI. Rose Dyspnea Scale scores range from 0 to 4 with higher scores indicating more dyspnea with common activities. A total of 800 (81%) reported some dyspnea at baseline with a mean (±SD) Rose Dyspnea Scale of 2.8±1.2. Dyspnea improvement was defined as a ≥1 point decrease in Rose Dyspnea Scale from baseline to 1 month. Predictors of dyspnea improvement were examined with a modified Poisson regression model. Patients with dyspnea were more likely to be female, obese, smokers, and to have more comorbidities and angina. Among patients with baseline dyspnea, 70% reported less dyspnea at 1 month after CTO PCI. Successful CTO PCI was associated with more frequent dyspnea improvement than failure, even after adjustment for other clinical variables. Anemia, depression, and lung disease were associated with less dyspnea improvement after PCI. CONCLUSIONS Dyspnea is a common symptom among patients undergoing CTO PCI and improves significantly with successful PCI. Patients with other potentially noncardiac causes of dyspnea reported less dyspnea improvement after CTO PCI.
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Affiliation(s)
- Mohammed Qintar
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.).
| | - J Aaron Grantham
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.)
| | - James Sapontis
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.)
| | - Kensey L Gosch
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.)
| | - William Lombardi
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.)
| | - Dimitri Karmpaliotis
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.)
| | - Jeffery Moses
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.)
| | - Adam C Salisbury
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.)
| | - David J Cohen
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.)
| | - John A Spertus
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.)
| | - Suzanne V Arnold
- From the Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (M.Q., J.A.G., K.L.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, University of Missouri-Kansas City (M.Q., J.A.G., A.C.S., D.J.C., J.A.S., S.V.A.); the Department of Cardiology, Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine (SCS at Monash), Monash University, Melbourne, Australia (J.S.); the Department of Cardiology, University of Washington, Seattle (W.L.); the Department of Cardiology, Columbia University, New York City, NY (D.K., J.M.)
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Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document. Circulation 2018; 137:2635-2650. [DOI: 10.1161/circulationaha.117.029289] [Citation(s) in RCA: 227] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Garcia-Garcia HM, McFadden EP, Farb A, Mehran R, Stone GW, Spertus J, Onuma Y, Morel MA, van Es GA, Zuckerman B, Fearon WF, Taggart D, Kappetein AP, Krucoff MW, Vranckx P, Windecker S, Cutlip D, Serruys PW. Standardized End Point Definitions for Coronary Intervention Trials. Eur Heart J 2018; 39:2192-2207. [DOI: 10.1093/eurheartj/ehy223] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/11/2018] [Indexed: 01/01/2023] Open
Affiliation(s)
- Hector M Garcia-Garcia
- Cardialysis, Rotterdam, The Netherlands
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Andrew Farb
- US Food and Drug Administration, Washington, DC, USA
| | - Roxana Mehran
- Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, US
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation and Division of Cardiology, Columbia University Medical Center, New York, US
| | - John Spertus
- Mid America Heart Institute, University of Missouri, Kansas City, USA
| | | | | | | | | | | | - David Taggart
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Arie-Pieter Kappetein
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Canter, Rotterdam, The Netherlands
| | - Mitchell W Krucoff
- Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina, US
| | - Pascal Vranckx
- Hartcentrum Hasselt and Faculty of Medicine and Life Sciences University of Hasselt, Hasselt, Belgium
| | | | - Donald Cutlip
- Harvard Clinical Research Institute, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick W Serruys
- Centre for International Cardiovascular Health, Imperial College London UK
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Grodzinsky A, Kosiborod M, Tang F, Jones PG, McGuire DK, Spertus JA, Beltrame JF, Jang JS, Goyal A, Butala NM, Yeh RW, Arnold SV. Residual Angina After Elective Percutaneous Coronary Intervention in Patients With Diabetes Mellitus. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.003553. [PMID: 28904076 DOI: 10.1161/circoutcomes.117.003553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 08/04/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies suggest that among patients with stable coronary artery disease, patients with diabetes mellitus (DM) have less angina and more silent ischemia when compared with those without DM. However, the burden of angina in diabetic versus nondiabetic patients after elective percutaneous coronary intervention (PCI) has not been recently examined. METHODS AND RESULTS In a 10-site US PCI registry, we assessed angina before and at 1, 6, and 12 months after elective PCI with the Seattle Angina Questionnaire angina frequency score (range, 0-100, higher=better). We also examined the rates of antianginal medication prescriptions at discharge. A multivariable, repeated-measures Poisson model was used to examine the independent association of DM with angina over the year after treatment. Among 1080 elective PCI patients (mean age, 65 years; 74.7% men), 34.0% had DM. At baseline and at each follow-up, patients with DM had similar angina prevalence and severity as those without DM. Patients with DM were more commonly prescribed calcium channel blockers and long-acting nitrates at discharge (DM versus not: 27.9% versus 20.9% [P=0.01] and 32.8% versus 25.5% [P=0.01], respectively), whereas β-blockers and ranolazine were prescribed at similar rates. In the multivariable, repeated-measures model, the risk of angina was similar over the year after PCI in patients with versus without DM (relative risk, 1.04; range, 0.80-1.36). CONCLUSIONS Patients with stable coronary artery disease and DM exhibit a burden of angina that is at least as high as those without DM despite more antianginal prescriptions at discharge. These findings contradict the conventional teachings that patients with DM experience less angina because of silent ischemia.
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Affiliation(s)
- Anna Grodzinsky
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.).
| | - Mikhail Kosiborod
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
| | - Fengming Tang
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
| | - Philip G Jones
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
| | - Darren K McGuire
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
| | - John A Spertus
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
| | - John F Beltrame
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
| | - Jae-Sik Jang
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
| | - Abhinav Goyal
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
| | - Neel M Butala
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
| | - Robert W Yeh
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
| | - Suzanne V Arnold
- From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.)
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Lee YM, Kim RB, Lee HJ, Kim K, Shin MH, Park HK, Ahn SK, Kim SY, Lee YH, Kim BG, Lee H, Lee WK, Lee KS, Kim MJ, Park KS. Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study. Health Qual Life Outcomes 2018; 16:100. [PMID: 29788961 PMCID: PMC5964665 DOI: 10.1186/s12955-018-0921-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/30/2018] [Indexed: 12/17/2022] Open
Abstract
Background The healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. Although the healthy adherer effect is supposed to affect health outcomes in patients with coronary artery disease, evaluation of its presence and extent is not easy. This study aimed to assess the relationship between medication adherence and lifestyle modifications and health-related quality of life among post-acute myocardial infarction (AMI) patients. Methods A cross-sectional study was conducted in 417 post-AMI patients who underwent percutaneous coronary intervention (PCI). Patients were recruited from 11 university hospitals from December 2015 to March 2016 in South Korea. Details regarding socio-demographic factors, six health behaviors (low-salt intake, low-fat diet and/or weight-loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation), medication adherence using the Modified Morisky Scale (MMS), and HRQoL using the Coronary Revascularization Outcome Questionnaire (CROQ) were surveyed in a one-on-one interview. Results In the univariate logistic analysis, sex (female), age (≥70 years), MMS score (≥5), and CROQ score were associated with adherence to lifestyle modification. In the multiple logistic analysis, a high MMS score (≥5) was associated with adherence to lifestyle modification after adjusting for sex, age, marital status, education, and family income (adjusted odds ratio [OR] = 11.7, 95% confidence interval [CI] = 1.5–91.3). After further adjusting for the CROQ score, the association between high MMS score and adherence to lifestyle modification was significant (adjusted OR = 11.5, 95% CI = 1.4–93.3). Conclusions Adherence to medication was associated with adherence to lifestyle modification, suggesting the possible presence of the healthy adherer effect in post-AMI patients. After further adjusting for HRQoL, the association remained. To improve health outcome in post-AMI patients, early detection of patients with poor adherence to medication and lifestyle modification and motivational education programs to improve adherence are important. In addition, the healthy adherer effect should be considered in clinical research, in particular, in studies evaluating the effects of therapies on health outcomes. Electronic supplementary material The online version of this article (10.1186/s12955-018-0921-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu-Mi Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Rock Bum Kim
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, South Korea.,Department of Preventive Medicine, College of Medicine and Institute of Health Science, Gyeongsang National University, 15 Jinju-daero, 816 Beon-gil, Jinju, 52727, South Korea
| | - Hey Jean Lee
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Chuncheon, South Korea
| | - Keonyeop Kim
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyeung-Keun Park
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, South Korea
| | - Soon-Ki Ahn
- Daejeon-Chungnam Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, South Korea
| | - So Young Kim
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University Hospital, Cheongju, South Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine &Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, South Korea
| | - Byoung-Gwon Kim
- Busan-Ulsan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, South Korea
| | - Heeyoung Lee
- Center for preventive medicine and public health, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Won Kyung Lee
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, South Korea
| | - Mi-Ji Kim
- Department of Preventive Medicine, College of Medicine and Institute of Health Science, Gyeongsang National University, 15 Jinju-daero, 816 Beon-gil, Jinju, 52727, South Korea
| | - Ki-Soo Park
- Department of Preventive Medicine, College of Medicine and Institute of Health Science, Gyeongsang National University, 15 Jinju-daero, 816 Beon-gil, Jinju, 52727, South Korea.
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41
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Stolker JM, Jones PG, Spertus JA. Defining the Severity and Duration of Health Status Decrements Due to Restenosis. Am J Cardiol 2018. [PMID: 29519543 DOI: 10.1016/j.amjcard.2018.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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42
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Kim HS, Kim HK, Kang KO, Kim YS. Determinants of health-related quality of life among outpatients with acute coronary artery disease after percutaneous coronary intervention. Jpn J Nurs Sci 2018; 16:3-16. [DOI: 10.1111/jjns.12209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 11/19/2017] [Accepted: 01/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hee Sun Kim
- College of Nursing, Research Institute of Nursing Science; Chonbuk National University; Jeonju South Korea
| | - Hyun Kyung Kim
- College of Nursing, Research Institute of Nursing Science; Chonbuk National University; Jeonju South Korea
| | - Kyung Ok Kang
- Chonbuk National University Hospital; Jeonju South Korea
| | - Yi Sik Kim
- Division of Cardiology, Department of Internal Medicine; Chonbuk National University Hospital; Jeonju South Korea
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Patient-Reported Outcomes in Revascularization Decisions for Left-Main Disease: Sharing the EXCELlence. J Am Coll Cardiol 2017; 70:3123-3126. [PMID: 29097295 DOI: 10.1016/j.jacc.2017.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/22/2017] [Indexed: 11/24/2022]
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44
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Qintar M, Towheed A, Tang F, Salisbury AC, Ho PM, Grantham JA, Spertus JA, Arnold SV. The Impact of De-escalation of Antianginal Medications on Health Status After Percutaneous Coronary Intervention. J Am Heart Assoc 2017; 6:e006405. [PMID: 29054844 PMCID: PMC5721850 DOI: 10.1161/jaha.117.006405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/03/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antianginal medications (AAMs) can be perceived to be less important after percutaneous coronary intervention (PCI) and may be de-escalated after revascularization. We examined the frequency of AAM de-escalation at discharge post-PCI and its association with follow-up health status. METHODS AND RESULTS In a 10-center PCI registry, the Seattle Angina Questionnaire was assessed before and 6 months post-PCI. AAM de-escalation was defined as fewer AAMs at discharge versus admission or >25% absolute dose decrease. Of 2743 PCI patients (70% male), AAM were de-escalated, escalated, and unchanged in 299 (11%), 714 (26%), and 1730 (63%) patients, respectively. Patients whose AAM were de-escalated were more likely to report angina at 6 months, compared with unchanged or escalated AAM (34% versus 24% versus 21%; P<0.001). The association of AAM de-escalation with health status was examined using multivariable models adjusting for the predicted risk of post-PCI angina, completeness of revascularization, and the interaction of AAM de-escalation×completeness of revascularization. There was a significant interaction between AAM de-escalation and completeness of revascularization (P<0.001), suggesting that AAM de-escalation was associated with greater impairment of health status among patients with incomplete revascularization. In patients with incomplete revascularization, de-escalation of AAM at discharge was associated with 43% increased angina risk (relative risk, 1.43; 95% confidence interval, 1.26-1.63) and worse angina-related health status at 6 months post-PCI. CONCLUSIONS De-escalation of AAM occurs in 1 in 10 patients post-PCI, and it is associated with an increased risk of angina and worse health status, particularly among those with incomplete revascularization.
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Affiliation(s)
- Mohammed Qintar
- Saint Luke's Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Arooge Towheed
- Saint Luke's Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
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45
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Fanaroff AC, Kaltenbach LA, Peterson ED, Hess CN, Cohen DJ, Fonarow GC, Wang TY. Management of Persistent Angina After Myocardial Infarction Treated With Percutaneous Coronary Intervention: Insights From the TRANSLATE-ACS Study. J Am Heart Assoc 2017; 6:e007007. [PMID: 29051217 PMCID: PMC5721884 DOI: 10.1161/jaha.117.007007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Angina has important implications for patients' quality of life and healthcare utilization. Angina management after acute myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) is unknown. METHODS AND RESULTS TRANSLATE-ACS (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) was a longitudinal study of MI patients treated with percutaneous coronary intervention at 233 US hospitals from 2010 to 2012. Among patients with self-reported angina at 6 weeks post-MI, we described patterns of angina and antianginal medication use through 1 year postdischarge. Of 10 870 percutaneous coronary intervention-treated MI patients, 3190 (29.3%) reported angina symptoms at 6 weeks post-MI; of these, 658 (20.6%) had daily/weekly angina while 2532 (79.4%) had monthly angina. Among patients with 6-week angina, 2936 (92.0%) received β-blockers during the 1 year post-MI, yet only 743 (23.3%) were treated with other antianginal medications. At 1 year, 1056 patients (33.1%) with 6-week angina reported persistent angina symptoms. Of these, only 31.2% had been prescribed non-β-blocker antianginal medications at any time in the past year. Among patients undergoing revascularization during follow-up, only 25.9% were on ≥1 non-β-blocker anti-anginal medication at the time of the procedure. CONCLUSIONS Angina is present in one third of percutaneous coronary intervention-treated MI patients as early as 6 weeks after discharge, and many of these patients have persistent angina at 1 year. Non-β-blocker antianginal medications are infrequently used in these patients, even among those with persistent angina and those undergoing revascularization.
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Affiliation(s)
- Alexander C Fanaroff
- Division of Cardiology, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
| | | | - Eric D Peterson
- Division of Cardiology, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Connie N Hess
- Division of Cardiology, University of Colorado, and CPC Clinical Research, Aurora, CO
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, CA
| | - Tracy Y Wang
- Division of Cardiology, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
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46
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Xue C, Bian L, Xie YS, Yin ZF, Xu ZJ, Chen QZ, Zhang HL, Fan YQ, Du R, Wang CQ. Low fT3 is associated with diminished health-related quality of life in patients with acute coronary syndrome treated with drug-eluting stent: a longitudinal observational study. Oncotarget 2017; 8:94580-94590. [PMID: 29212251 PMCID: PMC5706897 DOI: 10.18632/oncotarget.21811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/20/2017] [Indexed: 11/25/2022] Open
Abstract
Acute coronary syndrome (ACS) patients with low triiodothyronine (T3) syndrome characterized by low free T3 (fT3) levels with normal thyroxine (T4) and thyroid-stimulating hormone (TSH) have a higher rate of death. The impact of fT3 on Health related quality of life (HRQOL) in patients with ACS is still unknown. 528 ACS patients treated with drug-eluting stent (DES) were included in this prospective, observational study. Patients were classified into low fT3 group (n=126) and normal fT3 group (n=402) according to serum fT3 level. Every patient was prospectively interviewed at baseline and 1 year following percutaneous coronary intervention (PCI). HRQOL was assessed with the use of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Low fT3 patients had poorer HRQOL than normal fT3 patients both at baseline and 1-year follow-up (all p<0.05). During 1-year follow-up, HRQOL scores for all patients were significantly higher than baseline. Low fT3 patients had lesser gains in physical functioning, bodily pain, general health, vitality, social functioning and role emotional (all p<0.05). Generally, low fT3 patients demonstrated less improvement in Physical Component Score (PCS) (p=0.008) and Mental Component Score (MCS) (p=0.001). The percentage of patients reaching MCID for PCS and MCS was lower in low fT3 group than that in normal fT3 group (p<0.001). Multivariate linear regression analyses showed that low level of fT3 was an independent risk factor for PCS and MCS improvements. In conclusion, a low fT3 level is a predictor of worse HRQOL improvement in ACS patients treated with DES.
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Affiliation(s)
- Chao Xue
- Department of Cardiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, People's Republic of China
| | - Ling Bian
- Department of Cardiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, People's Republic of China
| | - Yu Shui Xie
- Department of Cardiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, People's Republic of China
| | - Zhao Fang Yin
- Department of Cardiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, People's Republic of China
| | - Zuo Jun Xu
- Department of Cardiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, People's Republic of China
| | - Qi Zhi Chen
- Department of Cardiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, People's Republic of China
| | - Hui Li Zhang
- Department of Cardiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, People's Republic of China
| | - Yu Qi Fan
- Department of Cardiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, People's Republic of China
| | - Run Du
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Chang Qian Wang
- Department of Cardiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, People's Republic of China
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Qintar M, Smolderen KG, Chan PS, Gosch KL, Jones PG, Buchanan DM, Girotra S, Spertus JA. Preinfarct Health Status and the Use of Early Invasive Versus Ischemia-Guided Management in Non-ST-Elevation Acute Coronary Syndrome. Am J Cardiol 2017; 120:1062-1069. [PMID: 28797471 PMCID: PMC5766265 DOI: 10.1016/j.amjcard.2017.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/22/2017] [Accepted: 06/15/2017] [Indexed: 12/01/2022]
Abstract
Early invasive management improves outcomes in non-ST-elevation myocardial infarction (NSTEMI). The association between preinfarct health status and the selecting patients for early invasive management is unknown. The Prospective Registry Evaluating outcomes after Myocardial Infarctions: Events and Recovery and Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients' Health status are consecutive US multicenter registries, in which the associations between preinfarct angina frequency and quality of life (both assessed by the Seattle Angina Questionnaire on admission) and the Global Registry of Acute Coronary Events (GRACE) risk score and referral to early invasive management (coronary angiography within 48 hours) were evaluated using Poisson regression, after adjusting for site, demographics, and clinical and psychosocial variables. Of 3,768 patients with NSTEMI, 2,182 (57.9%) patients were referred for early invasive treatment. Patients with excellent, good, or very good baseline angina-specific quality of life, respectively, were more likely to receive early angiography, even after adjustment, as compared with patients reporting poor baseline quality of life because of angina (62.1.0%, 60.9%, 59.6%, vs 51.2%; adjusted relative risk [RR] = 1.09, 95% confidence interval [CI] 1.04 to 1.16; RR = 1.13, 95% CI 1.01 to 1.27; RR 1.14, 95% CI 0.99 to 1.31, respectively). Finally, patients with a GRACE score in the highest risk decile (199.5 to <321.4) had significantly lower rates of early invasive treatment (42.7%) than patients in the lowest decile of risk (67.6%; adjusted RR for continuous GRACE score per SD [1 SD = 40 points], 0.96, 95% CI 0.92 to 0.99, p = 0.019). In conclusion, in this real-world NSTEMI cohort, patients with the highest mortality risk and worst health status were less likely to be referred for early invasive management. Further work is needed to understand the role of preinfarct health status and in-hospital treatment strategy.
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Affiliation(s)
- Mohammed Qintar
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
| | - Kim G Smolderen
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri; Ghent University, Ghent, Belgium
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Donna M Buchanan
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | | | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
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48
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Sun L, Xia M, Tang Y, Jones PG. Bayesian adjustment for unidirectional misclassification in ordinal covariates. J STAT COMPUT SIM 2017. [DOI: 10.1080/00949655.2017.1370649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Liangrui Sun
- Department of Statistics, University of Nebraska–Lincoln, Lincoln, NE, USA
| | - Michelle Xia
- Division of Statistics, Northern Illinois University, Dekalb, IL, USA
| | - Yuanyuan Tang
- Saint Luke's Mid America Heart Institute, Saint Luke's Hospital of Kansas City, Saint Luke's Health System, Kansas City, MO, USA
| | - Philip G. Jones
- Saint Luke's Mid America Heart Institute, Saint Luke's Hospital of Kansas City, Saint Luke's Health System, Kansas City, MO, USA
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49
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Odell A, Bång A, Andréll P, Widell C, Fryklund H, Kallryd A, Tygesen H, Grip L. Patients expectations and fulfilment of expectations before and after treatment for suspected coronary artery disease assessed with a newly developed questionnaire in combination with established health-related quality of life questionnaires. Open Heart 2017; 4:e000529. [PMID: 28698798 PMCID: PMC5495177 DOI: 10.1136/openhrt-2016-000529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 11/09/2022] Open
Abstract
Background Clinical decision-making is often based on evidence of outcome after a specific treatment. Healthcare providers and patients may, however, have different perceptions and expectations of what to achieve from a certain healthcare measure. Aims To evaluate patients’ expectations, perceptions and health related quality of life (HRQoL) before a care process including coronary angiography for suspected coronary artery disease and to evaluate the fulfilment of these expectations in relation to established patient reported outcome measures (PROMs) 6 months later. Furthermore, an aim was to try to define meaningful patient reported experience measures (PREMs) in this population. Methods 544 patients planned for coronary angiography completed a newly developed questionnaire to assess expectations and perceptions of treatment, the expectation questionnaire (ExpQ) and two established HRQoL questionnaires together with the established generic Short-Form 36 (SF36) and the disease specific Seattle Angina Questionnaire (SAQ). Results Patients had before the intervention, in general, high expectations of improvement after investigation and treatment and there was a positive attitude towards life style changes, medication and participation in decision-making regarding their own treatment. Only, 56.4% of the patients, however, reported fulfilment of treatment expectations. Fulfilment of treatment expectations correlated strongly with improvement in HRQoL after the care process. Conclusions To measure patients ´ expectations and fulfilments of these may offer simple and meaningful outcomes to evaluate a healthcare process from a patient ´s perspective. To approach patients’ expectations may also strengthen patient involvement in the care process with the possibilities of both higher patient satisfaction and medical results of the treatment.
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Affiliation(s)
- Annika Odell
- Department of Cardiology, The Medicine Institute of Sahlgrenska Academy, Gothenburg, Sweden
| | - Angela Bång
- Faculty of Caring Science, University of Borås, Borås, Sweden
| | - Paulin Andréll
- Multidisciplinary Pain Center, Sahlgrenska University Hospital and Institute of Medicine, Gothenburg, Sweden
| | - Charlotte Widell
- Department of Cardiology, The Medicine Institute of Sahlgrenska Academy, Gothenburg, Sweden
| | - Henrik Fryklund
- Department of Medicine, Norra lvsborg County Hospital, Trollhttan, Sweden
| | - Anders Kallryd
- Department of Medicine, Skaraborg Hospital, Skövde, Sweden
| | - Hans Tygesen
- Department of Medicine, Sothern Älvsborg Hospital, Borås, Sweden
| | - Lars Grip
- Department of Cardiology, The Medicine Institute of Sahlgrenska Academy, Gothenburg, Sweden
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50
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Kweon S, Sohn MK, Jeong JO, Kim S, Jeon H, Lee H, Ahn SC, Park SH, Jee S. Quality of Life and Awareness of Cardiac Rehabilitation Program in People With Cardiovascular Diseases. Ann Rehabil Med 2017; 41:248-256. [PMID: 28503458 PMCID: PMC5426264 DOI: 10.5535/arm.2017.41.2.248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/24/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the level of health-related quality of life (HRQoL), life satisfaction, and their present awareness of cardiac rehabilitation (CR) program in people with cardiovascular diseases. Methods A questionnaire survey was completed by 53 patients (mean age, 65.7±11.6 years; 33 men and 20 women) with unstable angina, myocardial infarction, or heart failure. The questionnaire included the Medical Outcome Study 36-item Short-Form Health Survey (MOS SF-36), life domain satisfaction measure (LDSM), and the awareness and degree of using CR program. Results The average scores of physical component summary (PCS) and mental component summary (MCS) were 47.7±18.5 and 56.5±19.5, respectively. There were significant differences in physical role (F=4.2, p=0.02), vitality (F=10.7, p<0.001), mental health (F=15.9, p<0.001), PCS (F=3.6, p=0.034), and MCS (F=11.9, p<0.001) between disease types. The average LDSM score was 4.7±1.5. Age and disease duration were negatively correlated with multiple HRQoL areas (p<0.05). Monthly income, ejection fraction, and LDSM were positively correlated with several MOS SF-36 factors (p<0.05). However, the number of modifiable risk factors had no significant correlation with medication. Thirty-seven subjects (69.8%) answered that they had not previously heard about CR program. Seventeen patients (32.1%) reported that they were actively participating in CR program. Most people said that a reasonable cost of CR was less than 100,000 Korean won per month. Conclusion CR should focus on improving the physical components of quality of life. In addition, physicians should actively promote CR to cardiovascular disease patients to expand the reach of CR program.
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Affiliation(s)
- Sehi Kweon
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jin Ok Jeong
- Department of Cardiology, Chungnam National University Hospital, Daejeon, Korea
| | - Soojae Kim
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hyunkyu Jeon
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hyewon Lee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Seung-Chan Ahn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Soo Ho Park
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
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