title: Association between appropriateness of coronary revascularization and quality of life in patients with stable ischemic heart disease.
abstract: BACKGROUND
  The relationship between appropriateness score, treatment strategy and quality of life (QOL) among patients with stable ischemic heart disease (SIHD) is not known. In this prospective cohort study, we evaluated changes in generic and cardiac-specific quality of life in patients with documented SIHD, comparing patients with revascularization versus those with medical therapy alone, stratified by their appropriateness scores.
  
  
  METHODS
  Consecutive patients with SIHD undergoing elective coronary angiogram from November 1st 2008 to December 1st 2009 completed the Seattle Angina Questionnaire (SAQ) and EQ-5D at the time of procedure and at 1 year. The appropriateness for coronary revascularization was determined at the time of coronary angiography.
  
  
  RESULTS
  Our final cohort consisted of 425 patients, 69.4% of whom underwent revascularization. In the overall cohort, 272 (64.0%) had appropriate indications for revascularization, while 57 (13.4%) had inappropriate indications and 96 (22.6%) had uncertain indications. On average, patients improved in most QOL domains, regardless of treatment strategy and appropriateness score. In patients with appropriate indications, revascularized patients had greater improvements in both generic (0.073; 95% CI 0.003-0.144; p-value 0.04) and disease-specific indices, including angina stability (14.6; 95% CI 0.85-28.3; p-value 0.04), physical limitation (9.3; 95% CI 0.71-17.8; p-value 0.03) and disease perception (12.7; 95% CI4.3-21.1; p-value 0.003) compared to medically treated patients. However, patients with uncertain and inappropriate indications also had improvements in physical limitation and disease perception with revascularization compared to medical therapy.
  
  
  CONCLUSIONS
  Patients who had appropriate revascularization derived the greatest improvement in QOL compared with medical therapy.
authors.affiliation: Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. harindra.wijeysundera@sunnybrook.ca.
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.forename: Feng
authors.initials: F
authors.lastname: Qiu
authors.forename: Paul
authors.initials: P
authors.lastname: Fefer
authors.forename: Maria C
authors.initials: MC
authors.lastname: Bennell
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D009864:Ontario; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D016896:Treatment Outcome