1
|
Dawson LP, Quinn S, Tong D, Boyle A, Hamilton-Craig C, Adams H, Layland J. Colchicine and quality of life in patients with acute coronary syndromes: Results from the COPS randomized trial. Cardiovasc Revasc Med 2022; 44:53-59. [PMID: 35739010 DOI: 10.1016/j.carrev.2022.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recent data suggest that colchicine may reduce cardiovascular events among patients presenting with acute coronary syndromes. This sub-study of the Australian COPS trial aimed to assess whether colchicine affects health status outcomes. METHODS Health status was assessed at baseline and 12-months using the EuroQol-5 Dimension 5-level (EQ-5D-5L) score and the full 19-question Seattle Angina Questionnaire (SAQ). Data were available for 786 patients (388 randomized to colchicine, 398 to placebo). RESULTS Baseline characteristics were well matched between groups; mean age was 60.1 (SD 14.8) years, and 20 % were female. Baseline health status scores were impaired, and most parameters demonstrated significant improvement from baseline to 12-months (EQ-5D-5L Visual Analogue Score [VAS] 69.3 to 77.7; SAQ angina frequency score 83.0 to 95.3, both p < 0.001). No significant differences in adjusted mean score change among any of the EQ-5D-5L or SAQ dimensions were observed between treatment groups in either intention-to-treat or per-protocol analysis. There were borderline interactions in EQ-5D-5L scores for those with previous MI vs not, and in SAQ scores for those with obesity vs not. In categorical analysis using observed data, patients treated with colchicine were more likely to have clinically significant improvement in physical limitation score over the period (36 % improved vs. 28 %, p < 0.05). Baseline health status scores were not associated with the primary endpoint at 12 months. CONCLUSIONS Treatment with colchicine did not appear to affect change in measures of health status following acute coronary syndromes, but it did lead to a greater likelihood of improvement in physical limitation scores. TRIAL REGISTRATION ACTRN, ACTRN12615000861550. Registered 18/08/2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368973.
Collapse
Affiliation(s)
- Luke P Dawson
- Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Stephen Quinn
- Swinburne University of Technology, Department of Health Science and Biostatistics, Hawthorn, Victoria, Australia
| | - David Tong
- Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia; St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Andrew Boyle
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Christian Hamilton-Craig
- The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Medicine, Griffith University, Australia
| | - Heath Adams
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Jamie Layland
- Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia.
| |
Collapse
|
2
|
Jelani QUA, Smolderen KG, Halpin D, Gosch K, Spertus JA, Iyad Ochoa Chaar C, Tutein Nolthenius RP, Heyligers J, De Vries JP, Mena-Hurtado C. Patient profiles and health status outcomes for peripheral artery disease in high-income countries: a comparison between the USA and The Netherlands. Eur Heart J Qual Care Clin Outcomes 2021; 7:505-512. [PMID: 32539108 DOI: 10.1093/ehjqcco/qcaa052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
AIMS Peripheral artery disease (PAD) is a global disease. Understanding variability in patient profiles and PAD-specific health status outcomes across health system countries can provide insights into improving PAD care. We compared these features between two high-income countries, the USA and The Netherlands. METHODS AND RESULTS Patients were identified from the patient-centred outcomes related to treatment practices in peripheral arterial disease: investigating trajectories study-a prospective, international registry of patients presenting to vascular specialty clinics for new onset, or exacerbation of PAD symptoms. PAD-specific health status was measured with the peripheral artery questionnaire. General linear mixed models for repeated measures were used to study baseline, 3, 6, and 12-month PAD-specific health status outcomes (peripheral artery questionnaire summary score) between the USA and The Netherlands. Out of a total of 1114 patients, 748 patients (67.1%) were from the USA and 366 (32.9%) from The Netherlands. US patients with PAD were older, with more financial barriers, higher cardiovascular risk factor burden, and lower referral rates for exercise treatment (P < 0.001). They had significantly worse PAD-specific adjusted health status scores at presentation, 3, 6, and 12 months of follow-up (all P < 0.0001). Magnitude of change in 1-year health status scores was smaller in the US cohort when compared with The Netherlands. CONCLUSION Compared with the Dutch cohort, US patients had worse adjusted PAD-specific health status scores at all time point, improving less over time, despite treatment. Leveraging inter-country differences in care and outcomes could provide important insights into optimizing PAD outcomes. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT01419080? term=portrait&rank=1 NCT01419080.
Collapse
Affiliation(s)
- Qurat-Ul-Ain Jelani
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 20 York St, New Haven 06520, CT, USA
| | - Kim G Smolderen
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 20 York St, New Haven 06520, CT, USA
| | - David Halpin
- David Halpin: Colorado Heart and Vascular Institute, 030 Mountain View Ave, Ste 300. Longmont, Colorado 80501, USA
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute/UMKC, 4401 Wornall Rd, Kansas Kansas City, MO 64111, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/UMKC, 4401 Wornall Rd, Kansas Kansas City, MO 64111, USA.,University of Missouri-Kansas City, 5000 Holmes St., Kansas City, MO 64110, USA
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, 20 YorK Street, New Haven, CT 06520, USA
| | - Rudolf P Tutein Nolthenius
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - Jan Heyligers
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,Department of Surgery, St Elisabeth Hospital, Hilvarenbeekse Weg 60, 5022 GC Tilburg, The Netherlands
| | - Jean-Paul De Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 20 York St, New Haven 06520, CT, USA
| |
Collapse
|
3
|
Rahman MM, Khanam R, Rahman M. Health care expenditure and health outcome nexus: new evidence from the SAARC-ASEAN region. Global Health 2018; 14:113. [PMID: 30466452 PMCID: PMC6249744 DOI: 10.1186/s12992-018-0430-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/02/2018] [Indexed: 11/27/2022] Open
Abstract
Background The total health expenditure (as a percentage of GDP) and health outcomes in the region of South Asian Association for Regional Cooperation (SAARC) and Association for South East Asian Nations (ASEAN) are lower than that of the OECD region and the world. This study investigated the relationship between different types of healthcare expenditures (public, private and total) and three main health status outcomes - life expectancy at birth, crude death rate and infant mortality rate - in the region. Methodology Using the World Bank data set for 15 countries over a 20-year period (1995–2014), a panel data analysis was conducted where relevant fixed and random effect models were estimated to determine the effects of healthcare expenditure on health outcomes. The main variables studied were total health expenditure, public health expenditure, private health expenditure, GDP per capita, improved sanitation, life expectancy at birth, crude death rate and infant mortality rate. Results Total health expenditure, public health expenditure and private health expenditure significantly reduced infant mortality rates, and, the extent of effect of private health expenditure was greater than that of public health expenditure. Private health expenditure also had a significant role in reducing the crude death rate. Per capita income growth and improved sanitation facilities also had significant positive roles in improving population health in the region. Conclusions Health expenditure in the SAARC-ASEAN region should be increased as our results indicated that it improved the health status of the population in the region. Public sector health funds must be appropriately and efficiently used, and accountability and transparency regarding spending of public health funds should be ensured. Finally, government and private institutes should implement appropriate strategies to improve sanitation facilities.
Collapse
Affiliation(s)
- Mohammad Mafizur Rahman
- Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia.
| | - Rasheda Khanam
- Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
| | - Maisha Rahman
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|