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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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Sacco A, Montalto C, Bravi F, Ruzzenenti G, Garatti L, Oreglia JA, Bartorelli AL, Crimi G, LA Vecchia C, Savonitto S, Leonardi S, Oliva FG, Morici N. Non-ST-elevation acute coronary syndrome in chronic kidney disease: prognostic implication of an early invasive strategy. Minerva Cardiol Angiol 2023; 71:44-50. [PMID: 35212503 DOI: 10.23736/s2724-5683.21.05839-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The optimal timing of PCI for NSTE-ACS with CKD is unclear. The aim of our study was to assess whether early percutaneous coronary intervention (PCI) (within 24 hours from admission) is associated with improved in-hospital (mortality or acute kidney injury) and long-term events (composite of mortality, myocardial infarction, stroke and bleeding events) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) with chronic kidney disease (CKD). METHODS We retrospectively studied NSTE-ACS patients who underwent PCI in large tertiary centers. CKD was defined as estimated glomerular filtration rate (eGFR)<60 mL/min/1.73 m2. A propensity score for the likelihood of an early invasive strategy was calculated. Relative risks (RR) and adjusted hazard ratios (HR) were estimated for in-hospital and follow-up events. RESULTS We included 821 patients, mean age was 69±12 years; 492 (60%) received an early PCI, and 273 (33%) had an eGFR <60. Median follow-up was 391 days. At univariate analysis, early treatment was associated with significantly lower in-hospital and follow-up events. However, after adjustment for major prognostic factors, there was no significant association with both in-hospital (RR=1.06; 95% CI 0.83-1.36) and follow-up events (RR=1.07; 95% CI 0.83-1.37). When the association was assessed in strata of CKD, lack of statistically significant association was confirmed, even if a trend emerged in patients with preserved renal function both on primary outcome (RR=0.47, 95% 0.18-1.22) and time to secondary outcome (HR=0.62, 95% CI 0.36-1.08). CONCLUSIONS In conclusion in a cohort of NSTE-ACS patients, an early invasive strategy does not independently affect prognosis.
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Affiliation(s)
- Alice Sacco
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
| | - Claudio Montalto
- University of Pavia and Coronary Care Unit, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giacomo Ruzzenenti
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Garatti
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jacopo A Oreglia
- Interventional Cardiology Division, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino IRCCS, Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gabriele Crimi
- Division of Cardiology, San Martino Hospital, Genoa, Italy
| | | | | | - Sergio Leonardi
- University of Pavia and Coronary Care Unit, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Fabrizio G Oliva
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Artha IMJR, Bakta IM, Manuaba IBP, Wita IW, Rohman MS, Astawa INM, Bhargah A. The Effects of Percutaneous Coronary Intervention on Biomarkers and Quality of Life in Patients With Chronic Total Coronary Artery Obstruction. Cardiol Res 2023; 14:69-78. [PMID: 36896223 PMCID: PMC9990544 DOI: 10.14740/cr1455] [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: 11/24/2022] [Accepted: 02/02/2023] [Indexed: 02/27/2023] Open
Abstract
Background Chronic total occlusion (CTO) is an angiographic picture of total occlusion without blood flow which is estimated to have lasted at least 3 months. This study attempted to provide an overview of the levels of matrix metalloproteinase-9 (MMP-9), soluble suppression tumorigenicity 2 (sST2), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) as remodeling, inflammatory, and atherosclerotic markers, as well as changes in the angina severity in patients with CTO who underwent percutaneous coronary intervention (PCI) compared to those without PCI. Methods This study is a preliminary report with quasi-experimental design study with a pre-test and post-test approach to compare PCI's effect in CTO patients towards changes in MMP-9, sST2, NT-pro-BNP levels, and changes in the angina severity. Twenty subjects underwent PCI and 20 subjects with optimal medical therapy, who were then assessed at baseline and 8 weeks after intervention. Results The results of this preliminary report showed that decreased MMP-9 (pre-test: 12.07 ± 1.27 ng/mL vs. post-test: 9.91 ± 5.19 ng/mL, P = 0.049), sST2 (pre-test: 37.65 ± 20.00 ng/mL vs. post-test: 29.74 ± 15.17 ng/mL, P = 0.026) and NT-pro-BNP (pre-test: 0.63 ± 0.23 ng/mL vs. post-test: 0.24 ± 0.10 ng/mL, P < 0.001) levels were found after 8 weeks of PCI compared to those without such intervention. The levels of NT-pro-BNP were lower in the PCI group (0.24 ± 0.10 ng/mL) than in the non-PCI group (0.56 ± 0.23 ng/mL; P < 0.001). Moreover, there was an improvement of angina severity in PCI group than without PCI (P < 0.039). Conclusions Although this preliminary report found a significant decrease in MMP-9, NT-pro-BNP, and sST2 levels in CTO patients who had undergone PCI compared to those without PCI, as well as improved angina severity in these patients, this study still has limitations. The number of samples was so small that similar studies with larger sample sizes or multicenter investigations are required to deliver more trustworthy and useful results. Nevertheless, we encourage this study as a preliminary baseline for further studies in the future.
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Affiliation(s)
- I Made Junior Rina Artha
- Cardiology and Vascular Medicine Department, Faculty of Medicine, Universitas Udayana-Prof. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - I Made Bakta
- Internal Medicine Department, Faculty of Medicine Universitas Udayana-Prof. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | | | - I Wayan Wita
- Cardiology and Vascular Medicine Department, Faculty of Medicine, Universitas Udayana-Prof. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Mohammad Saifur Rohman
- Department of Cardiology, Universitas Brawijaya-Saiful Anwar Hospital, Malang, Indonesia
| | - I Nyoman Mantik Astawa
- Virology Laboratory, Department of Animal Disease, Faculty of Veterinary Medicine, Universitas Udayana, Bali, Indonesia
| | - Agha Bhargah
- Cardiology and Vascular Medicine Department, Faculty of Medicine, Universitas Udayana-Prof. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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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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5
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Kim Y. Health-Related Quality of Life in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Cross-Sectional Study. J Nurs Res 2021; 30:e186. [PMID: 34720107 DOI: 10.1097/jnr.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The percutaneous coronary intervention (PCI) is the most common treatment for coronary artery disease. Health-related quality of life (HRQoL), alongside mortality and recurrence rates, is a key outcome indicator for PCI. PURPOSE The aim of this study was to investigate the factors influencing HRQoL in patients with coronary artery disease who had received PCI. METHODS A convenience sample from the cardiovascular center of a tertiary hospital in South Korea was recruited for this descriptive, cross-sectional study. This study was conducted using a structured questionnaire and patients' medical records on a sample of 210 patients with coronary artery disease who were ≥ 18 years old and > 1 month post-PCI. The questionnaire collected information on general, clinical, and psychosocial characteristics. Data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, the Scheffé test, and the Pearson correlation test. A multiple linear regression, together with the significant variables in univariate analysis, was used to determine the variables that significantly influenced HRQoL. RESULTS HRQoL was found to vary significantly with age, marital status, subjective economic status, primary caregiver, duration since first PCI, New York Heart Association class, anxiety, depression, and social support. The significant general characteristics shown to affect HRQoL in patients who had undergone PCI included age, marital status, and primary caregiver. The significant clinical characteristics shown to affect HRQoL included duration from first PCI and New York Heart Association class. The significant psychosocial characteristics shown to affect HRQoL included anxiety and depression. Primary caregiver and New York Heart Association class were identified as having the greatest impact on HRQoL in the PCI patients in this study. CONCLUSIONS To enhance HRQoL in patients who had received PCI, their post-PCI physical and psychological symptoms should be regularly assessed. Furthermore, intervention strategies aimed to improve quality of life in patients with severe functional limitations and those receiving family care are necessary.
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Affiliation(s)
- Yujeong Kim
- PhD, RN, APRN, Associate Professor, College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Republic of Korea
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6
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Tummala R, Shah SD, Rawal E, Sandhu RK, Kavuri SP, Kaur G, Khan AT, Mathialagan K, Ajibawo T. In-Hospital Mortality Risk Factor Analysis in Multivessel Percutaneous Coronary Intervention Inpatient Recipients in the United States. Cureus 2021; 13:e17520. [PMID: 34603890 PMCID: PMC8476197 DOI: 10.7759/cureus.17520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives The primary goal of our study is to evaluate the mortality rate in inpatient recipients of multivessel percutaneous coronary intervention (MVPCI) and to evaluate the demographic risk factors and medical complications that increase the risk of in-hospital mortality. Methods We conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS, 2016) and included 127,145 inpatients who received MVPCI as a primary procedure in United States' hospitals. We used a multivariable logistic regression model adjusted for demographic confounders to measure the odds ratio (OR) of association of medical complications and in-hospital mortality risk in MVPCI recipients. Results The in-hospital mortality rate was 2% in MVPCI recipients and was seen majorly in older-age adults (>64 years, 74%) and males (61%). Even though the prevalence of mortality among females was comparatively low, yet in the regression model, they were at a higher risk for in-hospital mortality than males (OR 1.2; 95% CI 1.13-1.37). While comparing ethnicities, in-hospital mortality was prevalent in whites (79%) followed by blacks (9%) and Hispanics (7.5%). Patients who developed cardiogenic shock were at higher odds of in-hospital mortality (OR 9.2; 95% CI 8.27-10.24) followed by respiratory failure (OR 5.9; 95% CI 5.39-6.64) and ventricular fibrillation (OR 3.5; 95% CI 3.18-3.92). Conclusion Accelerated use of MVPCI made it important to study in-hospital mortality risk factors allowing us to devise strategies to improve the utilization and improve the quality of life of these at-risk patients. Despite its effectiveness and comparatively lower mortality profile, aggressive usage of MVPCI is restricted due to the periprocedural complications and morbidity profile of the patients.
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Affiliation(s)
- Ravi Tummala
- Internal Medicine, Narayana Medical College, Nellore, IND
| | - Suchi D Shah
- Internal Medicine, Ahmedabad Municipal Corporation's Medical Education Trust Medical College, Ahmedabad, IND
| | - Era Rawal
- Cardiology, Norvic International Hospital, Kathmandu, NPL
| | - Ramneek K Sandhu
- Internal Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Swathi P Kavuri
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Gagan Kaur
- Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Asma T Khan
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | | | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
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7
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The ACIRA Registry: A Regional Tool to Improve the Healthcare Pathway for Patients Undergoing Percutaneous Coronary Interventions and Coronary Angiographies in the French Aquitaine Region: Study Design and First Results. Crit Pathw Cardiol 2021; 19:1-8. [PMID: 31567554 DOI: 10.1097/hpc.0000000000000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In France, there is a lack of information about practices and pathways of coronary angiographies and percutaneous coronary interventions (PCI). We present the design and the first results of the ACIRA registry, the goal of which is to answer questions about quality, security, appropriateness, efficiency of, and access to interventional cardiology (IC) healthcare pathway in the French Aquitaine region. METHODS The ACIRA registry is an on-going, multicenter, prospective, exhaustive, scalable, and nominative cohort study of patients who undergo coronary angiographies or percutaneous coronary intervention in any of the catheterization laboratories. The data related to hospitalizations and procedures are directly extracted from hospital information systems. In-hospital mortality, readmissions, and cardiovascular morbidity are collected from the French hospital medical information system database. An identity management system has been implemented to create the patient health care pathway. RESULTS From January 1, 2012, to June 30, 2018, 147,136 procedures performed on 106,005 patients have been included in the ACIRA registry. CONCLUSIONS ACIRA has shown its ability to study the patient IC healthcare pathway, up to 1 year after the procedure. Nominative data enable the linkage between clinical and medico-administrative databases and possible supplementary data collection. The use of existing databases allowed us to limit patients lost to follow-up, prevent the double entry of data, improve data quality, and reduce the operating costs. The prospect of linkage with the French National Health Data System may offer promising opportunities for future medical research projects and for developing collaboration and benchmarking with other IC registries abroad.
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Beska B, Coakley D, MacGowan G, Adams-Hall J, Wilkinson C, Kunadian V. Frailty and quality of life after invasive management for non-ST elevation acute coronary syndrome. Heart 2021; 108:203-211. [PMID: 33990413 DOI: 10.1136/heartjnl-2021-319064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Older patients presenting with non-ST elevation acute coronary syndrome (NSTEACS) require holistic assessment. We carried out a longitudinal cohort study to investigate health-related quality of life (HRQoL) of older, frail adults with NSTEACS undergoing coronary angiography. METHODS 217 consecutive patients aged ≥65 years (mean age 80.9±4.0 years, 60.8% male) with NSTEACS referred for coronary angiography were recruited from two tertiary cardiac centres between November 2012 and December 2015. Frailty was assessed with the Fried Frailty Index; a score of 0 was characterised as robust, 1-2 prefrail and ≥3 frail. The Short Form Survey 36 (SF-36), an HRQoL tool consisting of eight domains spanning physical and mental health, was performed at baseline and 1 year. RESULTS 186 patients (85.7%) had invasive revascularisation. At baseline, 52 (23.9%) patients were frail and 121 (55.8%) were prefrail, with most SF-36 domains falling below the norm-population mean. Patients with frailty had lower mean scores in all physical SF-36 domains (p≤0.05) compared with those without frailty. Robust patients had temporal improvement in two domains (role physical +5.80 (95% CI 1.31 to 10.3) and role emotional +6.46 (95% CI 1.02 to 11.9)) versus patients with frailty and prefrailty, who had a collective improvement in a greater number of physical and psychological domains at 1 year (2 domains vs 11 domains), notably role physical (prefrail +6.53 (95% CI 3.85 to 9.20) and frail +10.4 (95% CI 6.7814.1)). CONCLUSIONS Frail older adults with NSTEACS have poor HRQoL. One year following invasive management, there are modest improvements in HRQoL, most marked in frail and prefrail patients, who received a proportionally larger benefit than robust patients. TRIAL REGISTRATION NUMBER NCT01933581.
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Affiliation(s)
- Benjamin Beska
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daniel Coakley
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Guy MacGowan
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer Adams-Hall
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Chris Wilkinson
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK .,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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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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10
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Oreel TH, Nieuwkerk PT, Hartog ID, Netjes JE, Vonk ABA, Lemkes J, van Laarhoven HWM, Scherer-Rath M, Sprangers MAG, Henriques JPS. Gender differences in quality of life in coronary artery disease patients with comorbidities undergoing coronary revascularization. PLoS One 2020; 15:e0234543. [PMID: 32555617 PMCID: PMC7299316 DOI: 10.1371/journal.pone.0234543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022] Open
Abstract
In comparison to male patients with coronary artery disease, female patients suffer from more comorbidities, experience symptoms of coronary artery disease differently and report poorer health-related quality of life (HRQoL) after coronary revascularization. However, there is limited data on the impact of comorbidity burden on the recovery in HRQoL in female and male patients. We investigated the impact of comorbidity burden on the change in HRQoL following coronary revascularization in female patients versus male patients. 230 patients (60 female) with coronary artery disease were assessed before, and two weeks, three months and six months after coronary revascularization. Disease-specific HRQoL was measured with the Short-Form Seattle Angina Questionnaire. Physical and mental health was measured with the Short-Form Health Survey. Comorbidity burden was assessed by the total number of identified comorbidity conditions and by the Charlson comorbidity score. Linear mixed models were used to estimate the effects of time, gender and comorbidity burden on HRQoL. Whereas HRQoL improved after coronary revascularization in all patients, female patients reported poorer physical health and disease-specific HRQoL and their physical health improved more slowly than male patients. A higher comorbidity burden was related with poorer physical health and disease-specific HRQoL in male patients, but not in female patients. A higher comorbidity burden was associated with slower improvement in HRQoL for both female and male patients. Female patients reported poorer HRQoL and their physical health improved more slowly after coronary revascularization, irrespective of comorbidity burden. Higher comorbidity burden was associated with poorer physical health and disease-specific HRQoL in male patients only. Our results indicate that female and male patients recover differently after coronary revascularization. These findings highlight the importance of comorbidity- and gender-specific approaches for evaluating coronary artery disease and coronary revascularization procedures.
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Affiliation(s)
- Tom H. Oreel
- Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- * E-mail:
| | - Pythia T. Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Iris D. Hartog
- Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Justine E. Netjes
- Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Alexander B. A. Vonk
- Department of Cardio-thoracic Surgery, Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jorrit Lemkes
- Department of Cardiology, Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Scherer-Rath
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Mirjam A. G. Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - José P. S. Henriques
- Department of Cardiology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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11
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Spertus JA, Jones PG, Maron DJ, Mark DB, O'Brien SM, Fleg JL, Reynolds HR, Stone GW, Sidhu MS, Chaitman BR, Chertow GM, Hochman JS, Bangalore S. Health Status after Invasive or Conservative Care in Coronary and Advanced Kidney Disease. N Engl J Med 2020; 382:1619-1628. [PMID: 32227754 PMCID: PMC7255621 DOI: 10.1056/nejmoa1916374] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, -0.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, -2.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, -1.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, -2.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy. (Funded by the National Heart, Lung, and Blood Institute; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.).
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Affiliation(s)
- John A Spertus
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Philip G Jones
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - David J Maron
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Daniel B Mark
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Sean M O'Brien
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Jerome L Fleg
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Harmony R Reynolds
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Gregg W Stone
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Mandeep S Sidhu
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Bernard R Chaitman
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Glenn M Chertow
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Judith S Hochman
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
| | - Sripal Bangalore
- From Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City (J.A.S., P.G.J.), and the Center for Comprehensive Cardiovascular Care, St. Louis University School of Medicine, St. Louis (B.R.C.) - all in Missouri; the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.J.M., G.M.C.); Duke Clinical Research Institute, Durham, NC (D.B.M., S.M.O.); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.L.F.); and New York University Grossman School of Medicine (H.R.R., J.S.H., S.B.), Icahn School of Medicine at Mount Sinai (G.W.S.), and the Cardiovascular Research Foundation (G.W.S.), New York, and Albany Medical College and Albany Medical Center, Albany (M.S.S.) - all in New York
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12
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Chang Z, Guo AQ, Zhou AX, Sun TW, Ma LL, Gardiner FW, Wang LX. Nurse-led psychological intervention reduces anxiety symptoms and improves quality of life following percutaneous coronary intervention for stable coronary artery disease. Aust J Rural Health 2020; 28:124-131. [PMID: 31960537 DOI: 10.1111/ajr.12587] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/16/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To study the effect of nurse-led counselling on the anxiety symptoms and the quality of life following percutaneous coronary intervention for stable coronary artery disease. DESIGN Randomised control trial. SETTING Rural and remote China. PARTICIPANTS Rural and remote patients were consecutively recruited from a medical centre located in China between January and December 2014. INTERVENTIONS The control group received standard pre-procedure information from a ward nurse on the processes of the hospitalisation and percutaneous coronary intervention, and post-procedural care. The intervention group received a structured 30-minute counselling session the day before and 24 hours after the percutaneous coronary intervention, by nurse consultants with qualifications in psychological therapies and counselling. The health outcomes were assessed by a SF-12 scale and the Seattle Angina Questionnaire at 6 and 12 months after percutaneous coronary intervention. The anxiety and depression symptoms were evaluated by a Zung anxiety and depression questionnaire. MAIN OUTCOME MEASURES Cardiac outcomes, quality of life and mental health status. RESULTS Eighty patients were randomly divided into control (n = 40) and intervention groups (n = 40). There was a significant increase in the scores of the three domains of Seattle Angina Questionnaire 12 months after percutaneous coronary intervention in the intervention group (P < .01). The mental health and physical health scores also increased (P < .01). In the control group, the mean scores of Zung self-rating anxiety scale 12 months following percutaneous coronary intervention were higher than the baseline scores, and higher than in the intervention group (P < .01). CONCLUSIONS Counselling by a clinician qualified in psychological therapies and counselling significantly reduces anxiety symptoms and improves quality of life.
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Affiliation(s)
- Zongxia Chang
- Department of Cardiology and Nursing, Liaocheng People's Hospital, Liaocheng City, China
| | - Ai-Qing Guo
- Department of Cardiology and Nursing, Liaocheng People's Hospital, Liaocheng City, China
| | - Ai-Xia Zhou
- Department of Cardiology and Nursing, Liaocheng People's Hospital, Liaocheng City, China
| | - Tong-Wen Sun
- Henan Key Laboratory of Critical Care Medicine, Department of General ICU, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Long-le Ma
- Henan Key Laboratory of Critical Care Medicine, Department of General ICU, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fergus W Gardiner
- The Royal Flying Doctor Service, Canberra, ACT, Australia.,The Australian National University, Canberra, ACT, Australia
| | - Le-Xin Wang
- Department of Cardiology and Nursing, Liaocheng People's Hospital, Liaocheng City, China.,School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
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13
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Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis. Med J Islam Repub Iran 2019; 32:127. [PMID: 30815422 PMCID: PMC6387802 DOI: 10.14196/mjiri.32.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy.
Methods: Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software.
Results: A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I2 = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I2= 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy.
Conclusion: This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.
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14
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Sutton NR, Bates ER. Balancing the Benefits, Risks, and Costs of Chronic Total Occlusion Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019; 12:e007809. [DOI: 10.1161/circinterventions.119.007809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nadia R. Sutton
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Eric R. Bates
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
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15
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Kaambwa B, Gesesew H, Horsfall M, Chew DP. Impact of patient's health-related quality of life on physicians' therapy and perceived benefit in acute coronary syndromes: protocol for a systemic review of quantitative and qualitative studies. BMJ Open 2019; 9:e026595. [PMID: 30819712 PMCID: PMC6398748 DOI: 10.1136/bmjopen-2018-026595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Percutaneous coronary interventions (PCIs) and coronary angiography are two of the treatments administered to acute coronary syndrome (ACS) patients. However, whether and how patients' health-related quality of life (HRQoL) influences treatment decisions and subsequent risk benefit analyses is unclear. In this study, we will review the available evidence on the impact of patients' HRQoL on physicians' prescribing or treatment decisions and on the estimation of mortality and bleeding risk in ACS patients. METHODS AND ANALYSIS We will undertake a systematic review of all quantitative and qualitative studies. The search will include studies that describe the impact of HRQoL on prescribing PCIs or angiography, and impact of HRQoL on perceived risks in terms of mortality and bleeding events. We will conduct an initial search on Google scholar and MEDLINE to build the searching terms followed by a full search strategy using all identified keywords and index terms across the five databases, namely MEDLINE, PubMed, CINAHL, SCOPUS and Web of Sciences. We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for protocol guidelines to present the protocol. Only English language articles will be included for the review. We will use a standardised Joanna Briggs Institute data extraction tool to synthesise the information extracted from the selected studies into themes with summary findings presented in a table. ETHICS AND DISSEMINATION We will not require a formal ethical approval as we will not be collecting primary data. Review findings will be disseminated through a peer-reviewed publication, workshops, conference presentations and a media release. PROSPERO REGISTRATION NUMBER CRD42018108438.
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Affiliation(s)
- Billingsley Kaambwa
- Health Economics, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Hailay Gesesew
- Epidemiology, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
- Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Horsfall
- South Australian Health and Medical Research Institute, SAHMRI, Adelaide, South Australia, Australia
| | - Derek P Chew
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
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Riley RF, Sapontis J, Kirtane AJ, Karmpaliotis D, Kalra S, Jones PG, Lombardi WL, Grantham JA, McCabe JM. Prevalence, predictors, and health status implications of periprocedural complications during coronary chronic total occlusion angioplasty. EUROINTERVENTION 2018; 14:e1199-e1206. [PMID: 29808821 DOI: 10.4244/eij-d-17-00976] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Contemporary coronary chronic total occlusion (CTO) PCI has been associated with increased success rates. However, the rate of periprocedural complications for hybrid CTO PCI remains incompletely defined. We leveraged the OPEN CTO study in order to describe the prevalence, predictors, and health status outcomes of complications during contemporary CTO PCI. METHODS AND RESULTS Baseline demographics, procedural characteristics and rates of in-hospital complications were prospectively collected for 1,000 consecutive procedures at 12 expert US centres from 02/2014 to 07/2015. Multivariable logistic regression was used to evaluate the association of pre-specified anatomic and physiologic variables with complications. Patient-reported health status measures over the year following CTO PCI were also compared between those with and those without periprocedural complications. The overall complication rate was 9.7% (n=97/1,000). The most common adverse events were perforation (8.8%), periprocedural myocardial infarction (2.6%), arrhythmia requiring treatment (1.2%), cardiogenic shock (1.1%), and in-hospital death (0.9%). Independent predictors of complications during CTO PCI were: use of the retrograde approach (OR 1.98, 95% CI: 1.32-2.99), age (OR 1.30, 95% CI: 1.07-1.58 per 10-year increment), and J-CTO score (OR 1.20, 95% CI: 1.03-1.41 per one point increment). Mean health status scores over 12 months were worse for patients who experienced complications compared to those who did not, even after adjusting for baseline health status. CONCLUSIONS Complication rates for CTO PCI are more frequent than those reported for non-CTO PCI and were independently associated with retrograde approach, increasing age, and increasing lesion complexity. In addition, these periprocedural complications were also associated with worse long-term health status outcomes.
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Affiliation(s)
- Robert Francis Riley
- The Christ Hospital Heart and Vascular Center and The Lindner Research Center, Cincinnati, OH, USA
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Oldridge N, Cho C, Thomas R, Low M, Höfer S. Validation of the English Version of the HeartQoL Health-Related Quality of Life Questionnaire in Patients With Coronary Heart Disease. J Cardiopulm Rehabil Prev 2018; 38:92-99. [DOI: 10.1097/hcr.0000000000000248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Johnson NP, Gould KL, Di Carli MF, Taqueti VR. Invasive FFR and Noninvasive CFR in the Evaluation of Ischemia: What Is the Future? J Am Coll Cardiol 2017; 67:2772-2788. [PMID: 27282899 DOI: 10.1016/j.jacc.2016.03.584] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/07/2016] [Accepted: 03/15/2016] [Indexed: 12/14/2022]
Abstract
This review provides an integrative and forward-looking perspective on the gamut of coronary physiology for the diagnosis and management of atherosclerosis. Because clinical events serve as the ultimate gold standard, the future of all diagnostic tests, including invasive fractional flow reserve and noninvasive coronary flow reserve, depends on their ability to improve patient outcomes. Given the prominent role of acute coronary syndromes and invasive procedures in cardiology, we practically consider 2 broad categories of patients with coronary disease: acute and stable. For patients with acute coronary disease, coronary physiology may potentially refine treatment of the culprit lesion. For both patients with stable and acute nonculprit disease, reducing hard endpoints with revascularization potentially occurs at the severe end of the focal physiological spectrum, an area under-represented in existing trials. Nonepicardial disease and diffuse atherosclerosis remain underexplored aspects of coronary physiology for testing of novel treatments.
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Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas.
| | - K Lance Gould
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Marcelo F Di Carli
- Departments of Medicine and Radiology, Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, and the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Viviany R Taqueti
- Departments of Medicine and Radiology, Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, and the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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19
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Changing depressive symptoms following percutaneous coronary intervention, clustering and effect on adherence - The THORESCI study. J Affect Disord 2016; 204:146-53. [PMID: 27344624 DOI: 10.1016/j.jad.2016.06.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depressive symptom dimensions may have a differential effect on cardiac prognosis. It is yet unknown whether and how depressive symptoms change together over time and how this may affect disease progression. We examined the clustering of changing depressive symptoms over the first 6 months after percutaneous coronary intervention (PCI), and examined the influence of the change profile on the predictive value of depression for treatment adherence at 6 months post-PCI. METHODS PCI patients (N=219, age: 62±15, 20% women) reported on depressive symptoms (PHQ-9, BDI; 30 symptoms) and adherence (MOS-GAS) at 1 and 6 months post-PCI. Principal component analysis (PCA) was performed on the individual symptom change scores. Multivariable linear regression examined the role of change profiles in predicting general treatment adherence, while adjusting for demographic and clinical characteristics. RESULTS Four change-factors emerged from PCA. One somatic-affective change-factor (10 symptoms), two cognitive-affective change-factors (6 general cognitive-affective and 7 severe cognitive symptoms) and one mixed factor were identified. We extracted 5 symptom change profiles. Linear regression showed the moderating role of the change profiles. In patients reporting a net increase in depressive symptoms, higher cognitive affective symptoms (β=-.46, p=.001) and higher somatic-affective symptoms (β=-.29; p=.044) were associated with worse general adherence. DISCUSSION Four distinct depressive symptom change-factors were identified that moderated the association of somatic-affective and cognitive-affective depressive symptom levels with general treatment adherence. This is of clinical importance as not only current symptoms, but also symptom change over the preceding months may be important to consider in screening and risk prediction.
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20
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Takousi MG, Schmeer S, Manaras I, Olympios CD, Makos G, Troop NA. Health-Related Quality of Life after Coronary Revascularization: A systematic review with meta-analysis. Hellenic J Cardiol 2016; 57:S1109-9666(16)30145-2. [PMID: 27712910 DOI: 10.1016/j.hjc.2016.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 05/11/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis to summarize evidence and determine the impact of coronary revascularization (CR) on cardiac patients' Health-Related Quality of Life (HRQoL), highlighting factors that may affect this outcome in patients. METHODS A systematic search of Medline (Pubmed), EMBASE, Cochrane Library, Sciverse (Science Direct and Scopus) and PsycInfo was conducted to identify studies published from January 2000 to December 2012. Data were analyzed using MIX 2.0 Pro and SPSS 20. RESULTS Thirty-four longitudinal studies met the inclusion criteria; these studies included 15,992 patients, of whom 8,027 had undergone PCI, 6,348 had undergone CABG and 1,617 had received medication treatment. Moderate long-term effect sizes were revealed for both CR procedures. Both percutaneous coronary interventions (PCI) and coronary artery bypass graft surgery (CABG) had significantly greater effects on HRQoL than did medication; however, the CR procedures did not differ significantly from each other. Moderators included the type of instrument used to assess HRQoL and the study quality. Benefits related to physical functioning were greater than those related to psychosocial functioning in patients treated with CABG. CONCLUSIONS Empirical research highlights the positive effect of CR on patient HRQoL. Researchers should carefully select the instrument they use to measure HRQoL, as this may affect the results and thus conclusions. More RCTs and between-group studies employing pre-post designs should be conducted before clear conclusions can be drawn.
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Affiliation(s)
- Maria G Takousi
- Department of Psychology, Health & Human Sciences Research Institute, University of Hertfordshire, Hatfield, UK.
| | - Stefanie Schmeer
- Department of Psychology, Health & Human Sciences Research Institute, University of Hertfordshire, Hatfield, UK
| | - Irene Manaras
- School of Health Sciences, Metropolitan College, Athens, Greece
| | | | - Georgios Makos
- Department of Cardiothoracic surgery, Metropolitan Hospital, N. Faliro, Greece
| | - Nicholas A Troop
- Department of Psychology, Health & Human Sciences Research Institute, University of Hertfordshire, Hatfield, UK
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21
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Jørstad HT, Minneboo M, Helmes HJM, Fagel ND, Scholte Op Reimer WJ, Tijssen JGP, Peters RJG. Effects of a nurse-coordinated prevention programme on health-related quality of life and depression in patients with an acute coronary syndrome: results from the RESPONSE randomised controlled trial. BMC Cardiovasc Disord 2016; 16:144. [PMID: 27391321 PMCID: PMC4938968 DOI: 10.1186/s12872-016-0321-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/10/2016] [Indexed: 12/14/2022] Open
Abstract
Background Improvement of health-related quality of life (HRQOL) is an important goal in preventive cardiology. HRQOL is also related to depressive symptoms, which represent a common co-morbidity and risk factor in patients with an acute coronary syndrome (ACS). Comprehensive nurse-coordinated prevention programmes (NCPP) in secondary care have been shown to reduce cardiovascular risk, however their effects on HRQOL and depressive symptoms have not been evaluated. We therefore investigated HRQOL and depressive symptoms in a secondary analysis in the RESPONSE trial, evaluating the effect of a NCPP on cardiovascular risk. Methods RESPONSE was a multicentre (n = 11) randomised controlled trial in ACS-patients in secondary and tertiary healthcare settings evaluating a NCPP. The intervention consisted of four outpatient nurse clinic visits in the first 6 months after the index event, focusing on healthy lifestyles, biometric risk factors and medication adherence, in addition to usual care. The control group received usual care only. The outcome was change in HRQOL as measured by the MacNew questionnaire and change in depressive symptoms as measured by Beck’s Depression Inventory (BDI) questionnaire at 12-months follow-up relative to baseline. Results Of 754 patients randomised, 615 were analysed for HRQOL; 120 for depressive symptoms. At baseline, HRQOL was 5.17 (SD 1.09) and 5.20 (SD1.04) (scale range 1.0 to 7.0) in the intervention and control group, respectively. At 12 months follow-up, HRQOL increased by 0.57 (SD 0.89) in the intervention group as compared with 0.42 (SD 0.90) in the control group (p = 0.03). This increase was observed across all relevant subscales. The BDI decreased by 1.9 in the intervention group as compared with 0.03 in the control group (p = 0.03) (scale range 1.0 to 63). Conclusion Participation in a NCPP is associated with a modest but statistically significant increase in HRQOL, and a decrease of depressive symptoms, both of which are highly relevant to patients. A reduction in depressive symptoms may in addition contribute to a reduction in the overall risk of recurrent events. Trial registration Dutch trials register: NTR1290. Registered 24 April 2008.
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Affiliation(s)
- Harald T Jørstad
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Madelon Minneboo
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Harold J M Helmes
- Department of Cardiology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Nick D Fagel
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | - Jan G P Tijssen
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Atreya AR, Sivalingam SK, Arora S, Kashef MA, Fitzgerald J, Visintainer P, Lotfi A, Rothberg MB. Predictors of Medical Management in Patients Undergoing Elective Cardiac Catheterization for Chronic Ischemic Heart Disease. Clin Cardiol 2016; 39:207-14. [PMID: 26848560 DOI: 10.1002/clc.22510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/25/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Compared with medical therapy, percutaneous coronary intervention (PCI) does not reduce mortality or myocardial infarction in patients with stable angina. Therefore, PCI should be guided by refractory anginal symptoms and not just lesion characteristics. HYPOTHESIS We hypothesized that angiographic lesion characteristics and stress test results would have a greater role in the decision to proceed with PCI than would symptom severity. METHODS We performed a retrospective cohort study of patients undergoing elective cardiac catheterization and possible PCI at an academic medical center. Anginal symptoms, optimal medical therapy, antianginal therapy, stress test results, and angiographic lesions (including American College of Cardiology/American Heart Association [ACC/AHA] lesion type) were analyzed. Logistic regression was used to determine predictors of medical management among patients not referred for coronary artery bypass surgery. RESULTS Of the 207 patients with obstructive lesions amenable to PCI, 163 underwent PCI and 44 were referred to medical therapy. In the multivariable logistic model, the following variables were associated with medical management: advancing age (odds ratio [OR] per 1 year: 0.94, 95% confidence interval [CI]: 0.91-0.98), chronic kidney disease (OR: 0.23, 95% CI: 0.06-0.95), distal location (OR: 0.21, 95% CI: 0.09-0.48), and ACC/AHA type C lesion (OR: 0.08, 95% CI: 0.03-0.22). There was no association with sex, race, symptoms, optimal medical therapy, maximal antianginal therapy, referral status, or type of interventional cardiologist (academic vs private practice). CONCLUSIONS For patients undergoing cardiac catheterization for stable angina, the decision to proceed to PCI vs medical management appears to depend largely on patient and angiographic characteristics, but not on symptoms or ischemia. Distal and high-risk lesions (ACC/AHA type C) are more often referred for medical therapy.
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Affiliation(s)
- Auras R Atreya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Senthil K Sivalingam
- Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Sonali Arora
- Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Mohammad Amin Kashef
- Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Janice Fitzgerald
- Faculty and Resident Development, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Paul Visintainer
- Division of Epidemiology and Biostatistics, Baystate Medical Center, Springfield, Massachusetts
| | - Amir Lotfi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Michael B Rothberg
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Edward KL, Stephenson J, Giandinoto JA, Wilson A, Whitbourn R, Gutman J, Newcomb A. An Australian longitudinal pilot study examining health determinants of cardiac outcomes 12 months post percutaneous coronary intervention. BMC Cardiovasc Disord 2016; 16:31. [PMID: 26841927 PMCID: PMC4739379 DOI: 10.1186/s12872-016-0203-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 01/22/2016] [Indexed: 12/01/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) is a very common revascularisation procedure for coronary artery disease (CAD). The purpose of this study was to evaluate cardiac outcomes, health related quality of life (HRQoL), resilience and adherence behaviours in patients who have undergone a PCI at two time points (6 and 12 months) following their procedure. Methods A longitudinal pilot study was conducted to observe the cardiac outcomes across a cohort of patients who had undergone a percutaneous coronary intervention (PCI). Participants who had undergone PCI 6 months prior were invited. Those participants who met the inclusion criteria and provided consent then completed a telephone survey (time point 1). These participants were then contacted 6 months later (i.e. 12 months post-intervention, time point 2) and the measures were repeated. Results All patients (n = 51) were recorded as being alive at time point 1. The multiple model indicated that controlling for other factors, gender was significantly associated with a linear combination of outcome measures (p = 0.004). The effect was moderate in magnitude (partial-η2 = 0.303), where males performed significantly better than females 6 months after the PCI procedure physically and with mood. Follow-up univariate ANOVAs indicated that gender differences were grounded in the scale measuring depression (PHQ9) (p = 0.005) and the physical component score of the short form measuring HRQoL (SF12-PCS) (p = 0.003). Thirteen patients were lost to follow-up between time points 1 and 2. One patient was confirmed to have passed away. The pattern of correlations between outcome measures at time point 2 revealed statistically significant negative correlation between the PHQ instrument and the resilience scale (CD-RISC) (r = -0.611; p < 0.001); and the physical component score of the SF-12 instrument (r = -0.437; p = 0.054). Conclusions Men were performing better than women in the 6 months post-PCI, particularly in the areas of mood (depression) and physical health. This pilot results indicate gender-sensitive practices are recommended particularly up to 6 months post-PCI. Any gender differences observed at 6 month appear to disappear at 12 months post-PCI. Further research into the management of mood particularly for women post-PCI is warranted. A more detailed inquiry related to access/attendance to secondary prevention is also warranted.
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Affiliation(s)
- Karen-Leigh Edward
- Australian Catholic University and St Vincent's Private Hospital Melbourne Ltd, Locked Bag 4115 MDC, Fitzroy, 3065, Australia. .,University of Huddersfield, Huddersfield, United Kingdom.
| | - John Stephenson
- Australian Catholic University and St Vincent's Private Hospital Melbourne Ltd, Locked Bag 4115 MDC, Fitzroy, 3065, Australia. .,University of Huddersfield, Huddersfield, United Kingdom.
| | - Jo-Ann Giandinoto
- Australian Catholic University and St Vincent's Private Hospital Melbourne Ltd, Locked Bag 4115 MDC, Fitzroy, 3065, Australia.
| | - Andrew Wilson
- University of Melbourne and St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Robert Whitbourn
- University of Melbourne and St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Jack Gutman
- University of Melbourne and St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Andrew Newcomb
- University of Melbourne and St Vincent's Hospital Melbourne, Melbourne, Australia.
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Elbez Y, Cheong AP, Fassa AA, Cohen E, Reid CM, Babarskiene R, Bhatt DL, Steg PG. Clinical outcomes in patients with stable coronary artery disease with vs. without a history of myocardial revascularization. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2015; 2:23-32. [PMID: 29474584 DOI: 10.1093/ehjqcco/qcv017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Indexed: 11/12/2022]
Abstract
Aims The aim was to describe outcomes among patients with stable coronary artery disease (CAD) with or without a history of myocardial revascularization in a large contemporary cohort. Methods and results Patients with stable CAD were selected from the Reduction of Atherothrombosis for Continued Health (REACH) registry. The cohort was divided into patients with ( n = 25 583) and without ( n = 13 133) a history of myocardial revascularization. Crude outcomes were described according to the use and type of revascularization: percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). The primary outcome was cardiovascular (CV) death. At baseline, the non-revascularized group was older and had more CV risk factors. At 36-month median follow-up, previous revascularization was associated with a lower risk of CV death [crude incidence rate (CIR): 6.82 vs. 9.08%, hazard ratio (HR) 0.73 [95% confidence interval (CI) 0.66-0.80]; P < 0.01]. This association was seen for patients with a history of PCI (CIR 5.78 vs. 8.88%, HR 0.64 [0.58-0.71]; P ≤ 0.01), but not with CABG (HR 1.26 [1.14-1.49]; P < 0.01), and was consistent regardless of prior MI and the timing of prior revascularization. Conclusion Among patients with stable CAD, a history of myocardial revascularization was associated with lower CV mortality, particularly when PCI was the mode of revascularization. Coronary artery disease patients managed non-invasively represent a high-risk group.
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Affiliation(s)
- Yedid Elbez
- FACT, Département Hospitalo-Universitaire FIRE , AP-HP, Hôpital Bichat , 46 rue Henri Huchard, 75877 Paris Cedex 18 , France
| | - Adrian P Cheong
- FACT, Département Hospitalo-Universitaire FIRE , AP-HP, Hôpital Bichat , 46 rue Henri Huchard, 75877 Paris Cedex 18 , France
| | - Amir-Ali Fassa
- FACT, Département Hospitalo-Universitaire FIRE , AP-HP, Hôpital Bichat , 46 rue Henri Huchard, 75877 Paris Cedex 18 , France
| | - Eric Cohen
- Sunnybrook and Women's College Health Sciences Center , Toronto, ON , Canada
| | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School , Boston, MA , USA
| | - Philippe Gabriel Steg
- FACT, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.,Univ Paris-Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U-1148, F-75018 Paris, France.,NHLI, Imperial College, Royal Brompton Hospital, London, UK
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25
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Abbott JD. Measuring the Effectiveness of Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2015; 8:e003024. [PMID: 26253736 DOI: 10.1161/circinterventions.115.003024] [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] [Indexed: 11/16/2022]
Affiliation(s)
- J Dawn Abbott
- From the Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence.
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26
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Gould KL, Johnson NP, Kaul S, Kirkeeide RL, Mintz GS, Rentrop KP, Sdringola S, Virmani R, Narula J. Patient Selection for Elective Revascularization to Reduce Myocardial Infarction and Mortality. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.003099. [DOI: 10.1161/circimaging.114.003099] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- K. Lance Gould
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston and Memorial Hermann Hospital (K.L.G., N.P.J., R.L.K., S.S.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Department of Medicine, Cardiovascular Disease, New York Presbyterian Hospital, The University Hospital of Columbia and Cornell, New
| | - Nils P. Johnson
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston and Memorial Hermann Hospital (K.L.G., N.P.J., R.L.K., S.S.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Department of Medicine, Cardiovascular Disease, New York Presbyterian Hospital, The University Hospital of Columbia and Cornell, New
| | - Sanjay Kaul
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston and Memorial Hermann Hospital (K.L.G., N.P.J., R.L.K., S.S.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Department of Medicine, Cardiovascular Disease, New York Presbyterian Hospital, The University Hospital of Columbia and Cornell, New
| | - Richard L. Kirkeeide
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston and Memorial Hermann Hospital (K.L.G., N.P.J., R.L.K., S.S.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Department of Medicine, Cardiovascular Disease, New York Presbyterian Hospital, The University Hospital of Columbia and Cornell, New
| | - Gary S. Mintz
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston and Memorial Hermann Hospital (K.L.G., N.P.J., R.L.K., S.S.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Department of Medicine, Cardiovascular Disease, New York Presbyterian Hospital, The University Hospital of Columbia and Cornell, New
| | - K. Peter Rentrop
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston and Memorial Hermann Hospital (K.L.G., N.P.J., R.L.K., S.S.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Department of Medicine, Cardiovascular Disease, New York Presbyterian Hospital, The University Hospital of Columbia and Cornell, New
| | - Stefano Sdringola
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston and Memorial Hermann Hospital (K.L.G., N.P.J., R.L.K., S.S.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Department of Medicine, Cardiovascular Disease, New York Presbyterian Hospital, The University Hospital of Columbia and Cornell, New
| | - Renu Virmani
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston and Memorial Hermann Hospital (K.L.G., N.P.J., R.L.K., S.S.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Department of Medicine, Cardiovascular Disease, New York Presbyterian Hospital, The University Hospital of Columbia and Cornell, New
| | - Jagat Narula
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston and Memorial Hermann Hospital (K.L.G., N.P.J., R.L.K., S.S.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Cardiovascular Research Foundation, New York, NY (G.S.M.); Department of Medicine, Cardiovascular Disease, New York Presbyterian Hospital, The University Hospital of Columbia and Cornell, New
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Werdan K, Ebelt H, Nuding S, Höpfner F, Stöckl G, Müller-Werdan U. Ivabradine in combination with Beta-blockers in patients with chronic stable angina after percutaneous coronary intervention. Adv Ther 2015; 32:120-37. [PMID: 25687888 PMCID: PMC4349945 DOI: 10.1007/s12325-015-0182-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Indexed: 12/28/2022]
Abstract
Introduction The anti-anginal efficacy of ivabradine is well established. We describe a post hoc analysis in the ADDITIONS database to investigate effectiveness and tolerability of ivabradine in combination with beta-blocker in patients with angina who have had a percutaneous coronary intervention (PCI). Methods ADDITIONS was a non-interventional, multicenter prospective study including 2,330 patients with stable angina. In addition to beta-blocker, patients were treated with ivabradine in approved dosages for 4 months. We divided the population according to whether they had previously had a PCI or not, and explored the effect of ivabradine on heart rate, number of weekly angina attacks, frequency of nitrate consumption, as well as quality of life (QoL) and tolerability. Results Data were available for 2,319 patients, of whom 51.4% had previously had a PCI. There was no difference in the effect of ivabradine on mean heart rate between patients with a previous PCI [64.4 ± 7.6 beats per minute (bpm)] than those without (66.8 ± 8.5 bpm) at 4 months (both P < 0.0001). Similarly, the number of angina attacks decreased from 1.9 ± 2.4 to 0.5 ± 1.5 per week in patients with a previous PCI and 1.5 ± 2.0 to 0.3 ± 1.0 per week in patients without a previous PCI (both P < 0.0001). The frequency of nitrate consumption fell from 2.7 ± 3.7 to 1.0 ± 1.9 per week and 1.8 ± 2.8 to 0.6 ± 1.5 per week (both P < 0.0001) in patients with and without a previous PCI, respectively. There was no difference in the improvements in Canadian Cardiovascular Society class of angina, QoL, and physicians’ assessment of effectiveness and tolerability between patients with a previous PCI and those without. Conclusion Ivabradine is an effective and well-tolerated anti-anginal treatment in patients with stable angina after PCI. Ivabradine reduced the frequency of weekly angina attacks and nitrate consumption, led to an improvement in Canadian Cardiovascular Society class and a substantial improvement in the QoL of stable angina patients. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0182-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karl Werdan
- Department of Medicine and Heart Centre, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany,
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28
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Gada H, Moses JW. Adjudicating coronary revascularization: Appropriate Use Criteria are flawed and have been misapplied. Interv Cardiol 2015. [DOI: 10.2217/ica.14.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Blankenship JC. Chronic total quality of life. Catheter Cardiovasc Interv 2014; 84:635-6. [PMID: 25251708 DOI: 10.1002/ccd.25639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 08/15/2014] [Indexed: 11/10/2022]
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Rubin J, Kirtane AJ. Are the current American College of Cardiology/American Heart Association stable ischemic heart disease guidelines too conservative? Expert Rev Cardiovasc Ther 2014; 12:1125-8. [PMID: 25174357 DOI: 10.1586/14779072.2014.954552] [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] [Indexed: 11/08/2022]
Affiliation(s)
- Jonathan Rubin
- Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center at Columbia University Medical Center/New York-Presbyterian Hospital, and the Cardiovascular Research Foundation, 161 Fort Washington Ave, 6th Floor, New York, NY, USA
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Sipötz J, Friedrich O, Höfer S, Benzer W, Chatsakos T, Gaul G. Health related quality of life and mental distress after PCI: restoring a state of equilibrium. Health Qual Life Outcomes 2013; 11:144. [PMID: 23981730 PMCID: PMC3765885 DOI: 10.1186/1477-7525-11-144] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient self reported measures for Health Related Quality of Life (HRQOL) and mental distress are frequently used to evaluate outcome of therapeutic strategies in cardiac patients.Our study aims to describe changes in HRQOL and mental distress after percutaneous coronary intervention (PCI) focusing on temporal pattern of change and interdependences between both outcome measures. METHOD 163 PCI patients recruited at 7 cardiovascular care units in Austria answered MacNew Health Related Quality of Life and Hospital Anxiety and Depression Scale (HADS) questionnaires during hospital stay after intervention and at 1, 6, 12 and 24 months. RESULTS Improvement of MacNew HRQOL was found up to 6 month after PCI. Mental distress declined during the first month of the follow-up period. MacNew HRQOL is negatively correlated to mental distress. The relationship could be well described by a linear regression with MacNew HRQOL as dependent and HADS Total score as independent variable. The explained variance (R2) of the regression equation increases drastically from 45% at the baseline to a level between 67% and 77% in the follow up. CONCLUSION Our data suggest that the regression equation describing the relation between MacNew HRQOL and HADS-Total score six month after PCI defines a state of equilibrium: In absence of actual symptoms of coronary artery disease (CAD) both measures reflect the general health status and the general attitude underlying the self-assessment of health. At the baseline this equilibrium is imbalanced because the symptoms of CAD have a more pronounced impact on the disease specific MacNew HRQOL measure than on the non-disease specific HADS measure for mental distress. In order to use the MacNew questionnaire as a monitoring and/or prognostic tool it seems promising to refer to the state of equilibrium to define expectancy values for successful treatment.
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Affiliation(s)
- Johann Sipötz
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Vienna, Austria
- Department of Cardiology, Hanusch Krankenhaus, Vienna, Austria
| | - Oliver Friedrich
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Vienna, Austria
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria
| | - Werner Benzer
- Department of Interventional Cardiology, Academic Hospital Feldkirch, Feldkirch, Austria
| | | | - Georg Gaul
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Vienna, Austria
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Blankenship JC, Miller SC. Risky business: when patient preferences seem irrational. Catheter Cardiovasc Interv 2013; 82:219-20. [PMID: 23878033 DOI: 10.1002/ccd.25073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/09/2013] [Indexed: 11/09/2022]
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Morrison DA. There is nothing rotten (with elderly STEMI care) in the (Western) State of Denmark: Polonius: what do you read, my lord? Hamlet: words, words, words. Catheter Cardiovasc Interv 2013; 81:920-1. [PMID: 23606487 DOI: 10.1002/ccd.24922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/24/2013] [Indexed: 11/06/2022]
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Kirtane AJ, Marshall JJ. The benefit of ischemia-based revascularization for stable ischemic heart disease: the impact of FAME 2. Catheter Cardiovasc Interv 2013. [PMID: 23192971 DOI: 10.1002/ccd.24684] [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: 11/10/2022]
Affiliation(s)
- Ajay J Kirtane
- Columbia University Medical Center, New York Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA.
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