Comprehensive Quality-of-Life Outcomes With Invasive Versus Conservative Management of Chronic Coronary Disease in ISCHEMIA

ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) compared an initial invasive treatment strategy (INV) with an initial conservative strategy in 5179 participants with chronic coronary disease and moderate or severe ischemia. The ISCHEMIA researc...

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Published in:Circulation (New York, N.Y.) N.Y.), 2022-04, Vol.145 (17), p.1294-1307
Main Authors: Mark, Daniel B., Spertus, John A., Bigelow, Robert, Anderson, Sophia, Daniels, Melanie R., Anstrom, Kevin J., Baloch, Khaula N., Cohen, David J., Held, Claes, Goodman, Shaun G., Bangalore, Sripal, Cyr, Derek, Reynolds, Harmony R., Alexander, Karen P., Rosenberg, Yves, Stone, Gregg W., Maron, David J., Hochman, Judith S.
Format: Article
Language:English
Subjects:
Aged
angina pectoris
Angina Pectoris - therapy
Chronic Disease
Conservative Treatment
coronary angiography
coronary artery bypass
Coronary Disease
Female
health status
Humans
Ischemia
Male
myocardial ischemia
myocardial revascularization
Quality of Life
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Summary:ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) compared an initial invasive treatment strategy (INV) with an initial conservative strategy in 5179 participants with chronic coronary disease and moderate or severe ischemia. The ISCHEMIA research program included a comprehensive quality-of-life (QOL) substudy. In 1819 participants (907 INV, 912 conservative strategy), we collected a battery of disease-specific and generic QOL instruments by structured interviews at baseline; at 3, 12, 24, and 36 months postrandomization; and at study closeout. Assessments included angina-related QOL (19-item Seattle Angina Questionnaire), generic health status (EQ-5D), depressive symptoms (Patient Health Questionnaire-8), and, for North American patients, cardiac functional status (Duke Activity Status Index). Median age was 67 years, 19.2% were female, and 15.9% were non-White. The estimated mean difference for the 19-item Seattle Angina Questionnaire Summary score favored INV (1.4 points [95% CI, 0.2-2.5] over all follow-up). No differences were observed in patients with rare/absent baseline angina (SAQ Angina Frequency score >80). Among patients with more frequent angina at baseline (SAQ Angina Frequency score
ISSN:0009-7322
1524-4539
1524-4539
DOI:10.1161/CIRCULATIONAHA.121.057363