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Quality of life and economic outcomes with surgical ventricular reconstruction in ischemic heart failure: results from the Surgical Treatment for Ischemic Heart Failure trial.
- Source :
-
American heart journal [Am Heart J] 2009 May; Vol. 157 (5), pp. 837-44, 844.e1-3. Date of Electronic Publication: 2009 Apr 01. - Publication Year :
- 2009
-
Abstract
- 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.<br />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.<br />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.<br />Conclusions: Addition of SVR to CABG in patients with ischemic heart failure did not improve QOL but significantly increased health care costs.
- Subjects :
- Aged
Female
Follow-Up Studies
Health Care Costs trends
Heart Failure complications
Heart Failure psychology
Heart Ventricles physiopathology
Humans
Male
Middle Aged
Myocardial Ischemia complications
Myocardial Ischemia psychology
Retrospective Studies
Stroke Volume physiology
Surveys and Questionnaires
Treatment Outcome
United States
Ventricular Function, Left physiology
Coronary Artery Bypass methods
Heart Failure surgery
Heart Ventricles surgery
Myocardial Ischemia surgery
Quality of Life
Plastic Surgery Procedures methods
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6744
- Volume :
- 157
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- American heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 19376309
- Full Text :
- https://doi.org/10.1016/j.ahj.2009.03.008