Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization

Lenzen, Mattie, Scholte op Reimer, Wilma, Norekval, Tone M., De Geest, Sabina, Fridlund, Bengt, Heikkila, Johanna, Jaarsma, Tiny, Martensson, Jan, Moons, Philip, Smith, Karen, Stewart, Simon, Stromberg, Anna, Thompson, David R. and Wijns, William (2006) Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization. European Journal of Cardiovascular Nursing, 5 2: 115-121. doi:10.1016/j.ejcnurse.2006.01.003


Author Lenzen, Mattie
Scholte op Reimer, Wilma
Norekval, Tone M.
De Geest, Sabina
Fridlund, Bengt
Heikkila, Johanna
Jaarsma, Tiny
Martensson, Jan
Moons, Philip
Smith, Karen
Stewart, Simon
Stromberg, Anna
Thompson, David R.
Wijns, William
Title Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization
Journal name European Journal of Cardiovascular Nursing   Check publisher's open access policy
ISSN 1474-5151
1873-1953
Publication date 2006-06
DOI 10.1016/j.ejcnurse.2006.01.003
Volume 5
Issue 2
Start page 115
End page 121
Total pages 7
Editor T. Jaarsma
Place of publication Amsterdam ; London
Publisher Elsevier BV
Collection year 2006
Language eng
Subject C1
321003 Cardiology (incl. Cardiovascular Diseases)
730106 Cardiovascular system and diseases
110201 Cardiology (incl. Cardiovascular Diseases)
Abstract Background It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularization (EHSCR) provided an opportunity to assess pharmacological treatment and outcome in patients with proven CAD who were ineligible for revascularization. Methods We performed a secondary analysis of EHS-CR data. After excluding patients with ST-elevation myocardial infarction and those in whom revascularization was not indicated, 4409 patients remained in the analyses. We selected two groups: (1) patients in whom revascularization was the preferred treatment option (n = 3777, 86%), and (2) patients who were considered ineligible for revascularization (n = 632, 14%). Results Patient ineligible for revascularization had a worse risk profile, more often had a total occlusion (59% vs. 37%, p < 0.001), were treated more often with ACE-inhibitors (65% vs. 55%, p < 0.001) but less likely with aspirin (83% vs. 88%, p < 0.001). Overall, they had higher case-fatality at 1-year (7.0% vs. 3.7%, p < 0.001). Regarding self-perceived health status, measured via the EuroQol 5D (EQ-5D) questionnaire, these same patients reported more problems on all dimensions of the EQ-5D. Furthermore, in the revascularization group we observed an increase between discharge and 1-year follow up (utility score from 0.85 to 1.00) whereas patients ineligible for revascularization did not improve over time (utility score remained 0.80) Conclusion In this large cohort of European patients with CAD, those considered ineligible for revascularization had more co-morbidities and risk factors, and scored worse on self-perceived health status as compared to revascularized patients in the revascularization group. With the exception of ACE-inhibitors and aspirin, there were no major differences regarding drug treatment between the two groups. Given these clinically significant observations, there appears to be a role for nurse-led, multidisciplinary, rehabilitation teams that target clinically vulnerable patients whose symptoms remain refractory to standard medical care.
Keyword Chronic refractory angina;
Treatment
Health status
Euro Heart Survey
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

 
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Created: Wed, 15 Aug 2007, 10:09:55 EST