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Comprehensive Quali...
Comprehensive Quality-of-Life Outcomes With Invasive Versus Conservative Management of Chronic Coronary Disease in ISCHEMIA
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- Mark, Daniel B. (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Spertus, John A. (författare)
- Univ Missouri, St Lukes Mid Amer Heart Inst, Kansas City, MO 64110 USA.
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- Bigelow, Robert (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Anderson, Sophia (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Daniels, Melanie R. (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Anstrom, Kevin J. (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Baloch, Khaula N. (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Cohen, David J. (författare)
- Cardiovasc Res Fdn, New York, NY USA.;St Francis Hosp & Heart Ctr, Roslyn, NY USA.
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- Held, Claes, 1956- (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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- Goodman, Shaun G. (författare)
- Univ Toronto, St Michaels Hosp, Toronto, ON, Canada.;Canadian Heart Res Ctr, Toronto, ON, Canada.;Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada.
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- Bangalore, Sripal (författare)
- NYU Grossman Sch Med, New York, NY USA.
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- Cyr, Derek (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Reynolds, Harmony R. (författare)
- NYU Grossman Sch Med, New York, NY USA.
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- Alexander, Karen P. (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Rosenberg, Yves (författare)
- NHLBI, NIH, Bldg 10, Bethesda, MD 20892 USA.
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- Stone, Gregg W. (författare)
- Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA.
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- Maron, David J. (författare)
- Stanford Univ, Sch Med, Dept Med, Stanford, CA 94305 USA.
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- Hochman, Judith S. (författare)
- NYU Grossman Sch Med, New York, NY USA.
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Duke Univ, Duke Clin Res Inst, Durham, NC USA Univ Missouri, St Lukes Mid Amer Heart Inst, Kansas City, MO 64110 USA. (creator_code:org_t)
- Ovid Technologies (Wolters Kluwer Health), 2022
- 2022
- Engelska.
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Ingår i: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 145:17, s. 1294-1307
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- BACKGROUND: ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) compared an initial invasive treatment strategy (INV) with an initial conservative strategy in 5179 participants with chronic coronary disease and moderate or severe ischemia. The ISCHEMIA research program included a comprehensive quality-of-life (QOL) substudy.METHODS: In 1819 participants (907 INV, 912 conservative strategy), we collected a battery of disease-specific and generic QOL instruments by structured interviews at baseline; at 3, 12, 24, and 36 months postrandomization; and at study closeout. Assessments included angina-related QOL (19-item Seattle Angina Questionnaire), generic health status (EQ-5D), depressive symptoms (Patient Health Questionnaire-8), and, for North American patients, cardiac functional status (Duke Activity Status Index).RESULTS: Median age was 67 years, 19.2% were female, and 15.9% were non-White. The estimated mean difference for the 19-item Seattle Angina Questionnaire Summary score favored INV (1.4 points [95% CI, 0.2-2.5] over all follow-up). No differences were observed in patients with rare/absent baseline angina (SAQ Angina Frequency score >80). Among patients with more frequent angina at baseline (SAQ Angina Frequency score <80, 744 patients, 41%), those randomly assigned to INV had a mean 3.7-point higher 19-item Seattle Angina Questionnaire Summary score than conservative strategy (95% CI, 1.6-5.8) with consistent effects across SAQ subscales: Physical Limitations 3.2 points (95% CI, 0.2-6.1), Angina Frequency 3.2 points (95% CI, 1.2-5.1), Quality of Life/Health Perceptions 5.3 points (95% CI, 2.8-7.8). For the Duke Activity Status Index, no difference was estimated overall by treatment, but in patients with baseline SAQ Angina Frequency scores <80, Duke Activity Status Index scores were higher for INV (3.2 points [95% CI, 0.6-5.7]), whereas patients with rare/absent baseline angina showed no treatment-related differences. Moderate to severe depression was infrequent at randomization (11.5%-12.8%) and was unaffected by treatment assignment.CONCLUSIONS: In the ISCHEMIA comprehensive QOL substudy, patients with more frequent baseline angina reported greater improvements in the symptom, physical functioning, and psychological well-being dimensions of QOL when treated with an invasive strategy, whereas patients who had rare/absent angina at baseline reported no consistent treatment-related QOL differences.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- angina pectoris
- coronary angiography
- coronary artery bypass
- coronary disease
- health status
- myocardial ischemia
- myocardial revascularization
- quality of life
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Mark, Daniel B.
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Spertus, John A.
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Bigelow, Robert
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Anderson, Sophia
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Daniels, Melanie ...
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Anstrom, Kevin J ...
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Baloch, Khaula N ...
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Cohen, David J.
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Held, Claes, 195 ...
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Goodman, Shaun G ...
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Bangalore, Sripa ...
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Cyr, Derek
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Reynolds, Harmon ...
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Alexander, Karen ...
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Rosenberg, Yves
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Stone, Gregg W.
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Maron, David J.
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Hochman, Judith ...
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Uppsala universitet