Benzer Werner, Höfer Stefan, Oldridge Neil B
Department of Interventional Cardiology, Academic Hospital, Feldkirch, Austria.
Herz. 2003 Aug;28(5):421-8. doi: 10.1007/s00059-003-2388-9.
The assessment of health-related quality of life (HRQL) increasingly is an important outcome in the management and care of patients with angina. The aim of this study was to describe the baseline HRQL in patients with coronary artery disease (CAD) and angina and to report the impact of the three established therapeutic strategies, continued medical treatment (CMT), percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on HRQLover a 12-month follow-up period.
The change in specific HRQL scores and angina severity was evaluated in a routine clinical practice setting in 158 patients with CAD and angina treated either with CMT, PCI, or CABG. The measure used in this study to assess HRQL was the MacNew Heart Disease HROL Questionnaire (MacNew). It was administered before coronary angiography and 12 months after treatment stratification. Angina pectoris was assessed with the modified Canadian Cardiovascular Society's classification.
The MacNew discriminated between treatment groups with lowest (poorest HROL) baseline global, physical,and social HRQL scores seen in patients with subsequent CABG. There were significantly greater improvements in global and emotional HRQL scores after both PCI and CABG than after CMT. In all three treatment groups, improved HRQLscores were associated with improved angina grade.
The present study has shown clearly that evaluating HRQL as an outcome before and after different treatments for angina is feasible and useful in routine clinical practice. Measurement of HRQL discriminated between treatment groups at baseline and was responsive demonstrating improvement with each treatment alternative but most notably with CABG. The improved HROL was consistent with changes in angina severity. The MacNew may be useful when comparing outcomes across different treatments among patients with CAD and angina.
在心绞痛患者的管理与护理中，对健康相关生活质量（HRQL）的评估日益成为一项重要的结果指标。本研究的目的是描述冠心病（CAD）合并心绞痛患者的基线HRQL，并报告三种既定治疗策略，即持续药物治疗（CMT）、经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）在12个月随访期内对HRQL的影响。
在常规临床实践环境中，对158例接受CMT、PCI或CABG治疗的CAD合并心绞痛患者的特定HRQL评分和心绞痛严重程度变化进行了评估。本研究中用于评估HRQL的指标是MacNew心脏病HRQL问卷（MacNew）。在冠状动脉造影前以及治疗分层后12个月进行该问卷的评估。采用改良的加拿大心血管学会分类法评估心绞痛。
MacNew能够区分治疗组，接受后续CABG治疗的患者基线时的总体、身体和社会HRQL评分最低（HRQL最差）。PCI和CABG术后的总体和情感HRQL评分改善均显著大于CMT术后。在所有三个治疗组中，HRQL评分的改善与心绞痛分级的改善相关。
本研究清楚地表明，在心绞痛的不同治疗前后将HRQL作为一项结果指标进行评估在常规临床实践中是可行且有用的。HRQL的测量在基线时能够区分治疗组，并且具有反应性，表明每种治疗方案均有改善，但最显著的是CABG。HRQL的改善与心绞痛严重程度的变化一致。在比较CAD合并心绞痛患者不同治疗的结果时，MacNew可能会有所帮助。
