Health-related quality of life in patients with coronary artery disease after different treatments for angina in routine clinical practice.

Abstract

The assessment of health-related quality of life (HRQL) increasingly is an important outcome in the management and care of patients with angina. The aim of this study was to describe the baseline HRQL in patients with coronary artery disease (CAD) and angina and to report the impact of the three established therapeutic strategies, continued medical treatment (CMT), percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on HRQLover a 12-month follow-up period. The change in specific HRQL scores and angina severity was evaluated in a routine clinical practice setting in 158 patients with CAD and angina treated either with CMT, PCI, or CABG. The measure used in this study to assess HRQL was the MacNew Heart Disease HROL Questionnaire (MacNew). It was administered before coronary angiography and 12 months after treatment stratification. Angina pectoris was assessed with the modified Canadian Cardiovascular Society's classification. The MacNew discriminated between treatment groups with lowest (poorest HROL) baseline global, physical,and social HRQL scores seen in patients with subsequent CABG. There were significantly greater improvements in global and emotional HRQL scores after both PCI and CABG than after CMT. In all three treatment groups, improved HRQLscores were associated with improved angina grade. The present study has shown clearly that evaluating HRQL as an outcome before and after different treatments for angina is feasible and useful in routine clinical practice. Measurement of HRQL discriminated between treatment groups at baseline and was responsive demonstrating improvement with each treatment alternative but most notably with CABG. The improved HROL was consistent with changes in angina severity. The MacNew may be useful when comparing outcomes across different treatments among patients with CAD and angina.