INTERVENTIONAL CARDIOLOGY AND SURGERY

¹ The Swedish Council on Technology Assessment in Health Care, Stockholm, Sweden
² Departments of Medicine and Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
³ Departments of Medicine and Health Services, University of California, Los Angeles and RAND Corporation, Santa Monica, California, USA

Correspondence to:
Correspondence to:
Dr Bengt Brorsson, SBU, PO Box 5650, 114 86 Stockholm, Sweden;
brorsson{at}sbu.se

Objective: To assess the impact of coronary revascularisation on the health related quality of life (HRQOL) of patients with chronic stable angina compared with data from "community" norms four years following revascularisation.

Design: Prospective survey and review of medical records.

Setting: Seven of the eight public Swedish heart centres that performed coronary artery interventions.

Subjects: 827 patients aged 55–79 years with chronic stable angina who underwent coronary artery revascularisation in 1994 or 1995 and completed the four year HRQOL survey.

Main outcome measures: Five components of the Swedish quality of life survey.

Results: Compared with age and sex adjusted population norms, patients at baseline had significantly lower mean scores on all five functioning and wellbeing scales (p < 0.001). Four years after revascularisation, the mean levels of functioning and wellbeing were similar to those in the normative population (p > 0.05) except for quality of sleep (p < 0.001). The improvements were the same across age groups and for men and women. However, 36% of men and 55% of women were not completely free from angina by four years (p < 0.001). Men without angina after four years had better HRQOL than their community norms (p < 0.001) on all dimensions except quality of sleep (p > 0.05). Women without angina had less pain (p < 0.01) and better general health perception (p < 0.05) but similar physical functioning, quality of sleep, and emotional wellbeing compared with their community counterparts. Both men and women who had suffered at least one anginal attack during the preceding four weeks had significantly worse HRQOL by four years than their community norms (p < 0.01).

Conclusions: By four years following revascularisation, three fifths of patients with chronic stable angina were free of angina and their HRQOL was the same as or better than that of the general Swedish population. However, fewer than half of all women and two thirds of men who underwent revascularisation were angina-free after four years. Among patients with new or persistent angina, the HRQOL was worse than that in community norms.

Keywords: coronary artery bypass graft surgery; percutaneous transluminal coronary angioplasty; coronary artery revascularisation; quality of life; outcomes

Abbreviations: CABG, coronary artery bypass graft; HRQOL, health related quality of life; NHP, Nottingham health profile; PTCA, percutaneous transluminal coronary angioplasty; RITA, randomized intervention treatment of angina; SECOR/SBU, Swedish coronary revascularisation—Swedish Council on Technology Assessment; SWED-QUAL, Swedish quality of life survey

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