Abstract 12028: Mechanism of Change in Quality of Life Among Stable Coronary Patients with or without Percutaneous Coronary Intervention
Background: Health related quality of life data were measured repeatedly over time in the COURAGE trial, where percutaneous coronary intervention (PCI) plus intensive pharmacologic and lifestyle intervention (optimal medical therapy, OMT) was compared with OMT alone in reducing the risk of cardiovascular events in patients with stable coronary disease. In this study, we examined the mechanism of change in angina-related quality of life data.
Methods: A total of 2,287 patients were enrolled and followed for a median of 4.6 years. Angina-specific health status was assessed with the Seattle Angina Questionnaire (SAQ). Scores range from 0 to 100; higher scores indicate better health status. Censored growth curve modeling was conducted to reveal the nature and risk factors of SAQ score changes over time.
Results: The growth curve forms for each domain is quadratic with a steep upward trajectory from baseline to 6 or 12 months, followed by stability or a downward slope. Individual patients significantly differ in their average level of scores; on average individual patients experienced significant change on SAQ scores over time. The most important predictors of change in SAQ scores were age, the use of long-acting nitrates at randomization and several additional factors that differed by domain. Patients randomized to PCI experienced higher change per month but with a more rapidly decline rate of change over time (See Table). For example, patients with PCI had ∼20% higher initial monthly increases in SAQ Angina Frequency scores than for OMT (1.42 vs. 1.15), but also had larger rates of decline 23% later in follow-up than for OMT (-0.062 vs. -0.048).
Conclusions: Adding PCI to OMT significantly improved angina-related quality of life and health status but the pace of this improvement was reduced until it disappeared after about 1-2 years. Growth curve modeling can be utilized to capture advantages of PCI over OMT. Age and the use of long-acting nitrates were also predictors of change.
- Cardiovascular disease
- Quality of life
- Health policy
- Quality assessment
- Percutaneous coronary intervention
- © 2011 by American Heart Association, Inc.