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

Mattie Lenzen, Wilma Scholte op Reimer, Tone M. Norekval, Sabina De Geest, Bengt Fridlund, Johanna Heikkila, Tiny Jaarsma, Jan Martensson, Philip Moons, Karen Smith, Simon Stewart, Anna Stromberg, David R. Thompson, William Wijns

    Research output: Contribution to journalArticle

    25 Citations (Scopus)

    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.
    Original languageEnglish
    Pages (from-to)115-121
    Number of pages7
    JournalEuropean Journal of Cardiovascular Nursing
    Volume5
    Issue number2
    DOIs
    Publication statusPublished - Jun 2006

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    Health Status
    Coronary Artery Disease
    Pharmacology
    Therapeutics
    Angiotensin-Converting Enzyme Inhibitors
    Aspirin
    Surveys and Questionnaires
    Nurse's Role
    Rehabilitation
    Morbidity

    Keywords

    • Chronic refractory angina
    • Treatment
    • Health status
    • Euro Heart Survey

    Cite this

    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. / 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. In: European Journal of Cardiovascular Nursing. 2006 ; Vol. 5, No. 2. pp. 115-121.
    @article{64cf1f233ba745ffa917e701b13c1d87,
    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",
    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.",
    keywords = "Chronic refractory angina, Treatment, Health status, Euro Heart Survey",
    author = "Mattie Lenzen and {Scholte op Reimer}, Wilma and Norekval, {Tone M.} and {De Geest}, Sabina and Bengt Fridlund and Johanna Heikkila and Tiny Jaarsma and Jan Martensson and Philip Moons and Karen Smith and Simon Stewart and Anna Stromberg and Thompson, {David R.} and William Wijns",
    note = "dc.publisher: Elsevier Developed to identify the numbers of patients who have undergone cardiovascular intervention and yet still have ongoing angina i.e. those with intractable angina. Access to a substantial European dataset overcame the limitations of data from individual centres. Research Group 4 - Quality of Life and Quality of Care in Acute and Chronic Illness",
    year = "2006",
    month = "6",
    doi = "10.1016/j.ejcnurse.2006.01.003",
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    }

    Lenzen, M, Scholte op Reimer, W, Norekval, TM, De Geest, S, Fridlund, B, Heikkila, J, Jaarsma, T, Martensson, J, Moons, P, Smith, K, Stewart, S, Stromberg, A, Thompson, DR & Wijns, W 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, vol. 5, no. 2, pp. 115-121. https://doi.org/10.1016/j.ejcnurse.2006.01.003

    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.; Wijns, William.

    In: European Journal of Cardiovascular Nursing, Vol. 5, No. 2, 06.2006, p. 115-121.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - 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

    AU - Lenzen, Mattie

    AU - Scholte op Reimer, Wilma

    AU - Norekval, Tone M.

    AU - De Geest, Sabina

    AU - Fridlund, Bengt

    AU - Heikkila, Johanna

    AU - Jaarsma, Tiny

    AU - Martensson, Jan

    AU - Moons, Philip

    AU - Smith, Karen

    AU - Stewart, Simon

    AU - Stromberg, Anna

    AU - Thompson, David R.

    AU - Wijns, William

    N1 - dc.publisher: Elsevier Developed to identify the numbers of patients who have undergone cardiovascular intervention and yet still have ongoing angina i.e. those with intractable angina. Access to a substantial European dataset overcame the limitations of data from individual centres. Research Group 4 - Quality of Life and Quality of Care in Acute and Chronic Illness

    PY - 2006/6

    Y1 - 2006/6

    N2 - 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.

    AB - 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.

    KW - Chronic refractory angina

    KW - Treatment

    KW - Health status

    KW - Euro Heart Survey

    U2 - 10.1016/j.ejcnurse.2006.01.003

    DO - 10.1016/j.ejcnurse.2006.01.003

    M3 - Article

    VL - 5

    SP - 115

    EP - 121

    JO - European Journal of Cardiovascular Nursing

    JF - European Journal of Cardiovascular Nursing

    SN - 1474-5151

    IS - 2

    ER -