Quality of life and economic outcomes with surgical ventricular reconstruction in ischemic heart failure: results from the Surgical Treatment for Ischemic Heart Failure trial.
BACKGROUND
Surgical ventricular reconstruction (SVR) is used in conjunction with coronary artery bypass graft surgery (CABG) to improve left ventricular function and clinical outcomes in selected patients with ischemic heart failure. The impact of SVR on quality of life (QOL) and medical costs is unknown.


METHODS
We compared CABG plus SVR with CABG alone in 1,000 patients with ischemic heart failure, an anterior wall scar, and a left ventricular ejection fraction <or=0.35. In 991 (99% of eligible), we collected a battery of QOL instruments. The principal, prespecified QOL measure was the Kansas City Cardiomyopathy Questionnaire, which evaluates the effects of heart failure symptoms on QOL using a scale from 0 to 100 with higher scores indicating better QOL. Structured QOL interviews were conducted at baseline, 4, 12, 24, and 36 months post randomization and were >or=92% complete. Cost data were collected on 196 (98%) of 200 patients enrolled in the United States.


RESULTS
Heart-failure-related QOL outcomes did not differ between the 2 treatment strategies out to 3 years (median Kansas City Cardiomyopathy Questionnaire scores for CABG alone and CABG plus SVR, respectively: baseline 53 versus 54, P = .53; 3 years 85 versus 84, P = .89). There were no treatment-related differences in other QOL measures. In the US patients, total index hospitalization costs averaged over $14,500 higher for CABG plus SVR (P = .004) due primarily to 4.2 extra postoperative, high-intensity care days in the hospital.


CONCLUSIONS
Addition of SVR to CABG in patients with ischemic heart failure did not improve QOL but significantly increased health care costs.
Outcomes Research Group, Duke University Medical Center, Durham, NC, USA. daniel.mark@duke.edu
Daniel B
DB
Mark
J David
JD
Knight
Eric J
EJ
Velazquez
Jonathan G
JG
Howlett
John A
JA
Spertus
Ljubomir T
LT
Djokovic
Tina M
TM
Harding
Gena R
GR
Rankin
Laura A
LA
Drew
Bozena
B
Szygula-Jurkiewicz
Christopher
C
Adlbrecht
Kevin J
KJ
Anstrom
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends; D006333:Heart Failure / Q000150:complications / Q000523:psychology / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D016277:Ventricular Function, Left / Q000502:physiology