Impact of Secondary Cardiovascular Events on Health Status

• Published in: Value in health 2012, Vol.15 (1), p.175-182
• Main Authors: van Stel, Henk F., PhD, Busschbach, Jan J.V., PhD, Hunink, M.G. Myriam, MD, PhD, Buskens, Erik, MD, PhD
• Format: Article
• Language: English
• Subjects: Animals; Cardiovascular Diseases - complications; cardiovascular events; Clinical Trials as Topic; Coronary Disease - complications; Coronary Disease - surgery; coronary heart diseases; Female; Health Status; Humans; individual patient data; Internal Medicine; Male; Middle Aged; Myocardial Revascularization - adverse effects; outcome assessment (health care); Peripheral Arterial Disease - complications; Peripheral Arterial Disease - surgery; peripheral vascular disease; Quality of Life; technology assessment; Time Factors
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2011.09.004

Abstract Objectives Estimates regarding the impact of secondary cardiovascular events on health status in patients treated for cardiovascular disease are scarce and of limited accuracy. Methods We obtained individual patient data on health status (EuroQol five-dimensional questionnaire) and secondary cardiovascular events (death, myocardial infarction, cerebrovascular accidents, amputation, extracranial bleeding, and reinterventions) observed during 12 to 36 months of follow-up. Data originated from five completed clinical trials on revascularization in coronary heart disease ( n = 2593) or peripheral arterial disease (PAD; n = 1379). We used linear mixed-effects modeling to estimate the acute impact of the initial secondary event and the health status before and after the event. Results A total of 1595 patients had at least one secondary event. Loss of health status just before the event ranged from 0.36 utility score for amputation in women with PAD to zero for cerebrovascular accident in men with PAD. In patients with coronary heart disease, pre-event health status loss ranged from 0.34 for extracranial bleeding in women to 0.10 for myocardial infarction in women. The acute impact of secondary events ranged from minor deterioration for cerebrovascular accident (−0.03) to improvement after all other events, ranging from +0.01 for occlusion to +0.22 for amputation. Women had significantly lower pre-event scores than did men: −0.04 to −0.10 in coronary heart disease and −0.04 to −0.27 in PAD. Older patients had mostly large but insignificantly lower pre-event scores than did younger patients (range +0.04 to −0.67). Conclusions Secondary events after revascularization in patients with cardiovascular disease are associated with health status loss before the event, while acute impact of the events was mostly small.