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Published in: BMC Cardiovascular Disorders 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Harindra C Wijeysundera, Feng Qiu, Paul Fefer, Maria C Bennell, Peter C Austin, Dennis T Ko

Published in: BMC Cardiovascular Disorders | Issue 1/2014

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Abstract

Background

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

Methods

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

Results

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

Conclusions

Patients who had appropriate revascularization derived the greatest improvement in QOL compared with medical therapy.
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Literature
1.
go back to reference Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS: Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007, 356 (15): 1503-1516. 10.1056/NEJMoa070829.CrossRefPubMed Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS: Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007, 356 (15): 1503-1516. 10.1056/NEJMoa070829.CrossRefPubMed
2.
go back to reference Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF, MacGregor JM, Orchard TJ, Chaitman BR, Genuth SM, Goldberg SH, Hlatky MA, Jones TL, Molitch ME, Nesto RW, Sako EY, Sobel BE, Bari 2D Study Group: A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009, 360 (24): 2503-2515.CrossRefPubMed Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF, MacGregor JM, Orchard TJ, Chaitman BR, Genuth SM, Goldberg SH, Hlatky MA, Jones TL, Molitch ME, Nesto RW, Sako EY, Sobel BE, Bari 2D Study Group: A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009, 360 (24): 2503-2515.CrossRefPubMed
3.
go back to reference Trikalinos TA, Alsheikh-Ali AA, Tatsioni A, Nallamothu BK, Kent DM: Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet. 2009, 373 (9667): 911-918. 10.1016/S0140-6736(09)60319-6.CrossRefPubMedPubMedCentral Trikalinos TA, Alsheikh-Ali AA, Tatsioni A, Nallamothu BK, Kent DM: Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet. 2009, 373 (9667): 911-918. 10.1016/S0140-6736(09)60319-6.CrossRefPubMedPubMedCentral
4.
go back to reference Ko DT, Tu JV, Austin PC, Wijeysundera HC, Samadashvili Z, Guo H, Cantor WJ, Hannan EL: Prevalence and extent of obstructive coronary artery disease among patients undergoing elective coronary catheterization in New York State and Ontario. JAMA. 2013, 310 (2): 163-169. 10.1001/jama.2013.7834.CrossRefPubMed Ko DT, Tu JV, Austin PC, Wijeysundera HC, Samadashvili Z, Guo H, Cantor WJ, Hannan EL: Prevalence and extent of obstructive coronary artery disease among patients undergoing elective coronary catheterization in New York State and Ontario. JAMA. 2013, 310 (2): 163-169. 10.1001/jama.2013.7834.CrossRefPubMed
5.
go back to reference Ko DT, Tu JV, Samadashvili Z, Guo H, Alter DA, Cantor WJ, Hannan EL: Temporal trends in the use of percutaneous coronary intervention and coronary artery bypass surgery in New York State and Ontario. Circulation. 2010, 121 (24): 2635-2644. 10.1161/CIRCULATIONAHA.109.926881.CrossRefPubMed Ko DT, Tu JV, Samadashvili Z, Guo H, Alter DA, Cantor WJ, Hannan EL: Temporal trends in the use of percutaneous coronary intervention and coronary artery bypass surgery in New York State and Ontario. Circulation. 2010, 121 (24): 2635-2644. 10.1161/CIRCULATIONAHA.109.926881.CrossRefPubMed
6.
go back to reference Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA: ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report of the American College of Cardiology Foundation appropriateness criteria task force, Society for cardiovascular angiography and interventions, Society of thoracic surgeons, American association for thoracic surgery, American heart association, and the American society of nuclear cardiology: endorsed by the American society of echocardiography, the heart failure society of America, and the society of cardiovascular computed tomography. Circulation. 2009, 119 (9): 1330-1352.CrossRefPubMed Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA: ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report of the American College of Cardiology Foundation appropriateness criteria task force, Society for cardiovascular angiography and interventions, Society of thoracic surgeons, American association for thoracic surgery, American heart association, and the American society of nuclear cardiology: endorsed by the American society of echocardiography, the heart failure society of America, and the society of cardiovascular computed tomography. Circulation. 2009, 119 (9): 1330-1352.CrossRefPubMed
7.
go back to reference Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA: ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update a report of the American college of cardiology Foundation appropriate use criteria task force, Society for cardiovascular angiography and interventions, Society of thoracic surgeons, American association for thoracic surgery, American heart association, American Society of nuclear cardiology, and the society of cardiovascular computed tomography. J Am Coll Cardiol. 2012, 59 (9): 857-881. 10.1016/j.jacc.2011.12.001.CrossRefPubMed Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA: ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update a report of the American college of cardiology Foundation appropriate use criteria task force, Society for cardiovascular angiography and interventions, Society of thoracic surgeons, American association for thoracic surgery, American heart association, American Society of nuclear cardiology, and the society of cardiovascular computed tomography. J Am Coll Cardiol. 2012, 59 (9): 857-881. 10.1016/j.jacc.2011.12.001.CrossRefPubMed
8.
go back to reference Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, Fihn SD: Development and evaluation of the Seattle Angina questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol. 1995, 25 (2): 333-341. 10.1016/0735-1097(94)00397-9.CrossRefPubMed Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, Fihn SD: Development and evaluation of the Seattle Angina questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol. 1995, 25 (2): 333-341. 10.1016/0735-1097(94)00397-9.CrossRefPubMed
9.
go back to reference Brooks R: EuroQol: the current state of play. Health Policy. 1996, 37 (1): 53-72. 10.1016/0168-8510(96)00822-6.CrossRefPubMed Brooks R: EuroQol: the current state of play. Health Policy. 1996, 37 (1): 53-72. 10.1016/0168-8510(96)00822-6.CrossRefPubMed
10.
go back to reference Wijeysundera HC, Farshchi-Zarabi S, Witteman W, Bennell MC: Conversion of the Seattle Angina Questionnaire into EQ-5D utilities for ischemic heart disease: a systematic review and catalog of the literature. Clinicoecon Outcomes Res. 2014, 6: 253-268.CrossRefPubMedPubMedCentral Wijeysundera HC, Farshchi-Zarabi S, Witteman W, Bennell MC: Conversion of the Seattle Angina Questionnaire into EQ-5D utilities for ischemic heart disease: a systematic review and catalog of the literature. Clinicoecon Outcomes Res. 2014, 6: 253-268.CrossRefPubMedPubMedCentral
11.
go back to reference Brindis RG, Douglas PS, Hendel RC, Peterson ED, Wolk MJ, Allen JM, Patel MR, Raskin IE, Hendel RC, Bateman TM, Cerqueira MD, Gibbons RJ, Gillam LD, Gillespie JA, Hendel RC, Iskandrian AE, Jerome SD, Krumholz HM, Messer JV, Spertus JA, Stowers SA: ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association. J Am Coll Cardiol. 2005, 46 (8): 1587-1605. 10.1016/j.jacc.2005.08.029.CrossRefPubMed Brindis RG, Douglas PS, Hendel RC, Peterson ED, Wolk MJ, Allen JM, Patel MR, Raskin IE, Hendel RC, Bateman TM, Cerqueira MD, Gibbons RJ, Gillam LD, Gillespie JA, Hendel RC, Iskandrian AE, Jerome SD, Krumholz HM, Messer JV, Spertus JA, Stowers SA: ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association. J Am Coll Cardiol. 2005, 46 (8): 1587-1605. 10.1016/j.jacc.2005.08.029.CrossRefPubMed
12.
go back to reference Douglas PS, Khandheria B, Stainback RF, Weissman NJ, Brindis RG, Patel MR, Khandheria B, Alpert JS, Fitzgerald D, Heidenreich P, Martin ET, Messer JV, Miller AB, Picard MH, Raggi P, Reed KD, Rumsfeld JS, Steimle AE, Tonkovic R, Vijayaraghavan K, Weissman NJ, Yeon SB, Brindis RG, Douglas PS, Hendel RC, Patel MR, Peterson E, Wolk MJ, Allen JM: ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J Am Coll Cardiol. 2007, 50 (2): 187-204. 10.1016/j.jacc.2007.05.003.CrossRefPubMed Douglas PS, Khandheria B, Stainback RF, Weissman NJ, Brindis RG, Patel MR, Khandheria B, Alpert JS, Fitzgerald D, Heidenreich P, Martin ET, Messer JV, Miller AB, Picard MH, Raggi P, Reed KD, Rumsfeld JS, Steimle AE, Tonkovic R, Vijayaraghavan K, Weissman NJ, Yeon SB, Brindis RG, Douglas PS, Hendel RC, Patel MR, Peterson E, Wolk MJ, Allen JM: ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J Am Coll Cardiol. 2007, 50 (2): 187-204. 10.1016/j.jacc.2007.05.003.CrossRefPubMed
13.
go back to reference Douglas PS, Khandheria B, Stainback RF, Weissman NJ, Peterson ED, Hendel RC, Stainback RF, Blaivas M, Des Prez RD, Gillam LD, Golash T, Hiratzka LF, Kussmaul WG, Labovitz AJ, Lindenfeld J, Masoudi FA, Mayo PH, Porembka D, Spertus JA, Wann LS, Wiegers SE, Brindis RG, Douglas PS, Hendel RC, Patel MR, Peterson ED, Wolk MJ, Allen JM: ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress echocardiography: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine. J Am Coll Cardiol. 2008, 51 (11): 1127-1147. 10.1016/j.jacc.2007.12.005.CrossRefPubMed Douglas PS, Khandheria B, Stainback RF, Weissman NJ, Peterson ED, Hendel RC, Stainback RF, Blaivas M, Des Prez RD, Gillam LD, Golash T, Hiratzka LF, Kussmaul WG, Labovitz AJ, Lindenfeld J, Masoudi FA, Mayo PH, Porembka D, Spertus JA, Wann LS, Wiegers SE, Brindis RG, Douglas PS, Hendel RC, Patel MR, Peterson ED, Wolk MJ, Allen JM: ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress echocardiography: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine. J Am Coll Cardiol. 2008, 51 (11): 1127-1147. 10.1016/j.jacc.2007.12.005.CrossRefPubMed
14.
go back to reference Ko DT, Guo H, Wijeysundera HC, Natarajan MK, Nagpal AD, Feindel CM, Kingsbury K, Cohen EA, Tu JV: Cardiac Care Network of Ontario Variations in Revascularization Practice in Ontario Working G: Assessing the association of appropriateness of coronary revascularization and clinical outcomes for patients with stable coronary artery disease. J Am Coll Cardiol. 2012, 60 (19): 1876-1884. 10.1016/j.jacc.2012.06.056.CrossRefPubMed Ko DT, Guo H, Wijeysundera HC, Natarajan MK, Nagpal AD, Feindel CM, Kingsbury K, Cohen EA, Tu JV: Cardiac Care Network of Ontario Variations in Revascularization Practice in Ontario Working G: Assessing the association of appropriateness of coronary revascularization and clinical outcomes for patients with stable coronary artery disease. J Am Coll Cardiol. 2012, 60 (19): 1876-1884. 10.1016/j.jacc.2012.06.056.CrossRefPubMed
15.
go back to reference Bradley SM, Chan PS, Spertus JA, Kennedy KF, Douglas PS, Patel MR, Anderson HV, Ting HH, Rumsfeld JS, Nallamothu BK: Hospital percutaneous coronary intervention appropriateness and in-hospital procedural outcomes: insights from the NCDR. Circ Cardiovasc Qual Outcomes. 2012, 5 (3): 290-297. 10.1161/CIRCOUTCOMES.112.966044.CrossRefPubMedPubMedCentral Bradley SM, Chan PS, Spertus JA, Kennedy KF, Douglas PS, Patel MR, Anderson HV, Ting HH, Rumsfeld JS, Nallamothu BK: Hospital percutaneous coronary intervention appropriateness and in-hospital procedural outcomes: insights from the NCDR. Circ Cardiovasc Qual Outcomes. 2012, 5 (3): 290-297. 10.1161/CIRCOUTCOMES.112.966044.CrossRefPubMedPubMedCentral
16.
go back to reference Spertus JA, Bliven BD, Farner M, Gillen A, Hewitt T, Jones P, McCallister BD: Integrating baseline health status data collection into the process of care. Jt Comm J Qual Improv. 2001, 27 (7): 369-380.PubMed Spertus JA, Bliven BD, Farner M, Gillen A, Hewitt T, Jones P, McCallister BD: Integrating baseline health status data collection into the process of care. Jt Comm J Qual Improv. 2001, 27 (7): 369-380.PubMed
17.
go back to reference Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Fihn SD: Monitoring the quality of life in patients with coronary artery disease. Am J Cardiol. 1994, 74 (12): 1240-1244. 10.1016/0002-9149(94)90555-X.CrossRefPubMed Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Fihn SD: Monitoring the quality of life in patients with coronary artery disease. Am J Cardiol. 1994, 74 (12): 1240-1244. 10.1016/0002-9149(94)90555-X.CrossRefPubMed
18.
go back to reference Weintraub WS, Spertus JA, Kolm P, Maron DJ, Zhang Z, Jurkovitz C, Zhang W, Hartigan PM, Lewis C, Veledar E, Bowen J, Dunbar SB, Deaton C, Kaufman S, O'Rourke RA, Goeree R, Barnett PG, Teo KK, Boden WE, Mancini GB: Effect of PCI on quality of life in patients with stable coronary disease. N Engl J Med. 2008, 359 (7): 677-687. 10.1056/NEJMoa072771.CrossRefPubMed Weintraub WS, Spertus JA, Kolm P, Maron DJ, Zhang Z, Jurkovitz C, Zhang W, Hartigan PM, Lewis C, Veledar E, Bowen J, Dunbar SB, Deaton C, Kaufman S, O'Rourke RA, Goeree R, Barnett PG, Teo KK, Boden WE, Mancini GB: Effect of PCI on quality of life in patients with stable coronary disease. N Engl J Med. 2008, 359 (7): 677-687. 10.1056/NEJMoa072771.CrossRefPubMed
19.
go back to reference Spertus JA, Salisbury AC, Jones PG, Conaway DG, Thompson RC: Predictors of quality-of-life benefit after percutaneous coronary intervention. Circulation. 2004, 110 (25): 3789-3794. 10.1161/01.CIR.0000150392.70749.C7.CrossRefPubMed Spertus JA, Salisbury AC, Jones PG, Conaway DG, Thompson RC: Predictors of quality-of-life benefit after percutaneous coronary intervention. Circulation. 2004, 110 (25): 3789-3794. 10.1161/01.CIR.0000150392.70749.C7.CrossRefPubMed
Metadata
Title
Association between appropriateness of coronary revascularization and quality of life in patients with stable ischemic heart disease
Authors
Harindra C Wijeysundera
Feng Qiu
Paul Fefer
Maria C Bennell
Peter C Austin
Dennis T Ko
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2014
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/1471-2261-14-137

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