title: Visualization and dynamics of multidimensional health-related quality-of-life-adjusted overall survival: a new analytic approach.
abstract: BACKGROUND
  Vesnarinone Trial (VesT) was a three-armed, placebo-controlled, randomized clinical trial designed to study the effects of 30 mg or 60 mg/day vesnarinone. Certain contradictory results involving patient health-related quality-of-life (HRQOL) and overall survival (OS) have made a definitive and unified conclusion difficult.
  
  
  METHODS
  To reconcile these findings, we have focused on the HRQOL-adjusted OS, commonly known as quality-adjusted life years (QALYs). Currently, analyses of QALYs incorporate a single HRQOL subscale. However, the VesT HRQOL instrument had two subscales: physical (PHYS) and emotional (EMOT). We have developed new ways to visualize and compare EMOT- and PHYS-adjusted OS.
  
  
  RESULTS
  In each VesT arm, there was an increased probability of superior EMOT-adjusted OS, compared to PHYS-adjusted OS. The magnitude of these findings was comparable across trial arms. Despite inferior survival and superior EMOT and PHYS scores, the 60-mg/day arm presents similar EMOT- and PHYS-adjusted OS compared to the placebo arm.
  
  
  CONCLUSIONS
  We have provided a fresh perspective on the complex interactions between multiple HRQOL dimensions and OS. These novel methods address the burgeoning need for robust information on the interplay between OS and HRQOL from a patient, clinical care and public policy perspective.
authors.affiliation: Bluhm Carrdiovascular Institute, Northwestern University, 676 N St Clair St., Suite 1700, Chicago, IL, USA, aandrei@nmh.org.
authors.forename: Adin-Cristian
authors.initials: AC
authors.lastname: Andrei
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Grady
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011719:Pyrazines; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011804:Quinolines / Q000627:therapeutic use; D018434:Sickness Impact Profile; D013269:Stochastic Processes; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D002316:Cardiotonic Agents; D011719:Pyrazines; D011804:Quinolines; C041667:vesnarinone