Lower diastolic wall strain is associated with coronary revascularization in patients with stable angina

Background: Coronary revascularization by PCI is one of the most common medical procedures performed nationally. PCI for patients with chronic stable angina is performed primarily for symptomatic benefit, and has not been shown to provide survival benefit or reduction in MACE. Therefore, improvement in angina severity is an important marker of quality and procedural success for this patient population. Patient-reported outcome measures (PROMs) have been developed for chest pain and dyspnea which are valid and responsive to treatment, however they are not widely used in routine care. We present a model for use of PROMs in routine care. Methods and Results: Development of infrastructure to collect PROMs data and present it to medical providers was a strategic priority of Partners HealthCare. The health system funded a tablet computer software platform to efficiently collect PROMs responses from patients and integrate the responses in the electronic medical record. This platform was implemented in the catheterization laboratory at Massachusetts General Hospital, with a target population of patients with chronic stable angina presenting for diagnostic coronary angiography. Patients complete short-form Seattle Angina Questionnaires (SAQ-7), the Rose dyspnea scale, the short-form Patient Health Questionnaire (PHQ-2), and the PROMIS-10 general health-related quality of life instrument. These assessments take 5 to 10 minutes to perform while the patient is in the pre-procedure waiting room. A phased implementation resulted in a final program including pre-procedure measurement, presentation of data to clinical providers, and follow-up using an e-mail platform. The program successfully captured measures from 474 patients in the first six months of the program, comprising 57.9% of outpatient visits. The key factors for success were high-level leadership commitment, allocation of adequate resources, a user-friendly interface for patients and staff, easily interpretable measures, and clinical relevance. Conclusions: Our program demonstrates that the integration of patient-reported outcomes measurement is technically feasible in a real-world care environment. We share our experiences to provide others with a model for similar programs, and to accelerate implementation nationwide by helping others avoid pitfalls. We believe expansion of similar programs nationally may lead to more robust quality measurement infrastructure and higher-value care for patients.

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Long-term prognosis in stable angina; medical treatment or coronary revascularization in patients younger than 70years?

International Journal of Cardiology ◽

10.1016/j.ijcard.2009.10.020 ◽

2011 ◽

Vol 148 (1) ◽

pp. 43-47 ◽

Cited By ~ 4

Author(s):

Clara Carpeggiani ◽

Patrizia Landi ◽

Claudio Michelassi ◽

Elena Barberini ◽

Antonio L'Abbate

Keyword(s):

Medical Treatment ◽

Stable Angina ◽

Coronary Revascularization ◽

Long Term Prognosis

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Coronary Computed Tomographic Angiography Does Not Accurately Predict the Need of Coronary Revascularization in Patients with Stable Angina

Yonsei Medical Journal ◽

10.3349/ymj.2016.57.5.1079 ◽

2016 ◽

Vol 57 (5) ◽

pp. 1079 ◽

Cited By ~ 2

Author(s):

Sung-Jin Hong ◽

Ae-Young Her ◽

Yongsung Suh ◽

Hoyoun Won ◽

Deok-Kyu Cho ◽

...

Keyword(s):

Stable Angina ◽

Coronary Revascularization ◽

Computed Tomographic Angiography ◽

Coronary Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

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Antianginal Efficacy of Ivabradine in Patients With History of Coronary Revascularization

Angiology ◽

10.1177/0003319716630499 ◽

2016 ◽

Vol 68 (1) ◽

pp. 10-18 ◽

Cited By ~ 4

Author(s):

J. Zarifis ◽

V. Grammatikou ◽

M. Kallistratos ◽

A. Katsivas

Keyword(s):

Quality Of Life ◽

Stable Angina ◽

Coronary Revascularization ◽

History Of ◽

Artery Disease ◽

Noninterventional Study ◽

Revascularization Procedures ◽

Post Hoc ◽

Antianginal Efficacy

Although coronary revascularization procedures are widely performed in patients with coronary artery disease (CAD), angina is often reported, even after such procedures. This study evaluated the antianginal efficacy and effect of ivabradine treatment on quality of life (QOL) in patients with CAD and history of coronary revascularization. This is a post hoc analysis (926 post-revascularization patients) of a prospective, noninterventional study, which included 2403 patients with CAD and stable angina. The data were recorded at baseline, at 1 month and 4 months after inclusion. After ivabradine administration, mean number of anginal events decreased from 2.2 ± 2.3 (median: 2.0, minimum: 0.0, maximum: 21.0, range: 21.0) to 0.3 ± 0.6 (median: 0.0, minimum: 0.0, maximum: 7.0, range: 7.0) times/week ( P < .001), while nitroglycerin consumption decreased from 1.5 ± 2.2 (median: 1.0, minimum: 0.0, maximum: 20.0, range: 20.0) to 0.1 ± 0.4 times/week (median: 0.0, minimum: 0.0, maximum: 5.0, range: 5.0; P < .001). Quality of life improved at study completion compared to baseline ( P < .001). Ivabradine addition on top of optimal individualized dose of β-blockers is associated with decreased anginal events and improvement in QOL in patients with stable angina and history of coronary revascularization.

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