Chronic Stable Angina – QOL vs MACE Reduction Benefit with Intervention

Proceedings from 12th Biennial Meeting of the International Andreas Gruentzig Society:  Brazil – 2014

From Session 1: Coronary

Chronic Stable Angina – QOL vs MACE Reduction Benefit With Intervention

Moderator:  Steve Bailey
Panelists:  Larry Dean, George Hanzel, Tarek Helmy, Bonnie Weiner, Peter Wijngaard

Framing the question at hand, what is the state of the current knowledge?

Clinical statements and trials are increasingly focused on attempting to separate postprocedure clinical events from those related to the patient’s personal perceptions after having undergone cardiac intervention. In an era of equipoise and uncertainty in procedural outcome, patient preference is often a key deciding factor.

There are currently no generally accepted tools that are used in general clinical practice. Patients have not been involved in developing patient focused questions that can be captured in clinical databases. The current investigative tools often are lengthy and require special skills in interpreting and analyzing this information.

What are the Gaps in the current knowledge?

Quality of Life (QOL) Tools have been improved, but these outcomes are still subject to confounding factors such as comorbid illnesses, physician practice patterns, and access to health care. 

Current conventional metrics such as recurrent MI or angina relief may not accurately reflect patients values because they fail to take into account the patient’s perception of physical, emotional, social, work-related, and psychological impact of revascularization. There are only a few individuals or centers working to develop and validate outcomes measures.

The current tools also do not reflect the patient’s experience in the long-term (years) after revascularization and are not accepted by society or payors, so no “value” is placed upon QOL.

Our Summary and Recommendations:

Patient-centered outcomes are an area that needs more attention and investigation. Assuring informed consent will require our patients to participate in the decisions regarding therapies. In order for patients to understand these choices, they need to appreciate outcomes in terms of their quality of life.

We need to develop a consensus that QOL metrics are as important as percent stenosis and procedural success and therefore should be integrated into our initial and follow-up data. We need to consider the impact of atypical symptoms and silent ischemia in these evaluations. This will require acceptance and dissemination of specific and validated QOL instrument.

Consideration of newer and even non-traditional clinical research methods is needed (internet/social media). These methods will allow us to measure long-term follow-up in large populations.

Along with increased attention to measurement, we should also improve compliance with OMT and lifestyle changes to enhance QOL. We must implement more (non-traditional) clinical research that allows us to measure long-term follow-up in large populations.