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Patients undergoing elective percutaneous coronary intervention (PCI) stand to show considerable gains in quality of life after treatment, according to survey data released by the Society for Cardiovascular Angiography and Interventions (SCAI). To supplement those results, SCAI developed a consensus statement on quality of life that was published as an editorial online October 17, 2012, ahead of print in Catheterization and Cardiovascular Interventions.
SCAI President J. Jeffrey Marshall, MD, of the Northeast Georgia Heart Center (Gainesville, GA), told TCTMD in a telephone interview that he wants to encourage more focus on an issue “that has been pushed under a rug. . . . Having seen [firsthand] my parents go through this, I was quite impressed that quality of life following revascularization has been underappreciated.”
PCI: Before and After
On behalf of SCAI, Harris Interactive conducted an online survey in mid-2012 of 464 patients who received an invasive treatment strategy for CAD within the past 3 years. The cohort included 153 patients (33.0%) who underwent elective PCI and 150 (32.3%) who underwent elective CABG, while the remaining 161 patients (34.7%) had emergency procedures (PCI or CABG). Questions touched on several aspects of quality of life including relationships with friends, family, and spouse/significant other; financial security; participation in hobbies; sex; ability to work; opportunities for socializing; basic physical activity; and ability to do chores or run errands.
Before treatment, 53% of elective PCI patients had a very or somewhat negative view of their ability to perform basic physical activities, a proportion that decreased to 31% after intervention. Reductions in very or somewhat negative views were also seen regarding opportunities for socializing (41% vs. 29%), sex life (25% vs. 12%), ability to work (38% vs. 26%), relationships with family (18% vs. 7%), relationships with friends (18% vs. 9%), ability to do chores or run errands (37% vs. 30%), and relationships with spouse/significant other (21% vs. 14%).
Elective PCI also was associated with a rise in the proportion of patients who reported no symptoms (26% to 50%). Improvements in shortness of breath, fatigue/excessive tiredness, and chest discomfort/pain were identified. In addition, elective PCI patients returned to work nearly 3 times faster than elective CABG patients at a mean of 12.7 vs. 37.7 days. Emergency CABG/PCI patients took 30.5 days to resume working.
In each subgroup, most patients somewhat or strongly agreed that life had changed for the better after treatment, including 81% of those who received elective PCI, 78% of those who received elective CABG, and 73% of those who underwent emergent procedures. A smaller segment of PCI patients (16%) than CABG patients (34%) reported feeling like more of a burden on their family and friends post-treatment. Nearly half (46%) of emergency CABG/PCI patients felt burdensome.
For the editorial, James C. Blankenship, MD, of Geisinger Medical Center (Danville, PA), and colleagues reviewed data from the medical literature on quality of life after PCI in patients with stable CAD.
“PCI in [stable CAD patients] may improve symptoms and [quality of life], with the greatest benefits in patients with few comorbidities, severe angina, and potential for complete revascularization,” they write, noting that at the other end of the spectrum, severe comorbidities and lack of ischemic symptoms at baseline may translate into minimal benefit. Differences in quality of life associated with PCI, CABG, or medical therapy “are small enough and individual patients’ responses to treatment are variable enough that patient preferences should be considered in choosing treatment strategies for [stable CAD],” the authors advise.
Yet many physicians and patients tend to overestimate the benefits of intervention while underestimating medical therapy, they point out. Patients also tend to prefer treatments that are easier in the short term, even when there are more complications in the long term, so “the physician should make patients aware of the trade-offs they are considering.”
Dr. Marshall said that, overall, clinicians are good at communicating this complexity. “I do believe that interventional cardiologists, cardiologists, and cardiac surgeons are all interested in making sure that we teach our patients how to make the right decision,” he noted. “By and large, we do it well, but . . . what we tell them is not always what they hear.”
As such, the SCAI paper advises identifying optimal methods for educating both patients and physicians about realistic expectations concerning different treatment options.
2. Society for Cardiovascular Angiography and Interventions. Living Life to Your Heart’s Content [infographic]. http://www.scai.org/SecondsCount/News/Detail.aspx?cid=96d8716a-ff74-44cd-ae8a-b42d8456f3c0. Published October 17, 2012. Accessed October 18, 2012.
3. Harris Interactive Public Relations Research. SCAI Quality of Life Survey: Heart Disease and Quality of Life Patient Survey Report. Published July 18, 2012. Received October 18, 2012.