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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.
Eur J Cardiovasc Nurs. 2006 Jun; 5(2):115-21.EJ

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.

Authors+Show Affiliations

Department of Cardiology, Clinical Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16530486

Citation

Lenzen, Mattie, et al. "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 : Journal of the Working Group On Cardiovascular Nursing of the European Society of Cardiology, vol. 5, no. 2, 2006, pp. 115-21.
Lenzen M, Scholte op Reimer W, Norekvål TM, et al. 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. Eur J Cardiovasc Nurs. 2006;5(2):115-21.
Lenzen, M., Scholte op Reimer, W., Norekvål, T. M., De Geest, S., Fridlund, B., Heikkilä, J., Jaarsma, T., Mårtensson, J., Moons, P., Smith, K., Stewart, S., Strömberg, A., Thompson, D. R., & 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 : Journal of the Working Group On Cardiovascular Nursing of the European Society of Cardiology, 5(2), 115-21.
Lenzen M, et al. 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. Eur J Cardiovasc Nurs. 2006;5(2):115-21. PubMed PMID: 16530486.
* Article titles in AMA citation format should be in sentence-case
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 - Norekvål,Tone M, AU - De Geest,Sabina, AU - Fridlund,Bengt, AU - Heikkilä,Johanna, AU - Jaarsma,Tiny, AU - Mårtensson,Jan, AU - Moons,Philip, AU - Smith,Karen, AU - Stewart,Simon, AU - Strömberg,Anna, AU - Thompson,David R, AU - Wijns,William, Y1 - 2006/03/10/ PY - 2005/12/23/received PY - 2006/01/04/accepted PY - 2006/3/15/pubmed PY - 2006/7/15/medline PY - 2006/3/15/entrez SP - 115 EP - 21 JF - European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology JO - Eur J Cardiovasc Nurs VL - 5 IS - 2 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. SN - 1474-5151 UR - https://www.unboundmedicine.com/medline/citation/16530486/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_ L2 - https://journals.sagepub.com/doi/10.1016/j.ejcnurse.2006.01.003?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -