International Variation in Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights From the ISCHEMIA Trial.

IF 6.2 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Nobuhiro Ikemura, John A Spertus, Dan Nguyen, Zhuxuan Fu, Philip G Jones, Harmony R Reynolds, Sripal Bangalore, Balram Bhargava, Roxy Senior, Ahmed Elghamaz, Shaun G Goodman, Renato D Lopes, Radoslaw Pracoń, José López-Sendón, Aldo P Maggioni, Shun Kohsaka, Gregory A Roth, Harvey D White, Kreton Mavromatis, William E Boden, Fatima Rodriguez, Judith S Hochman, David J Maron
{"title":"International Variation in Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights From the ISCHEMIA Trial.","authors":"Nobuhiro Ikemura, John A Spertus, Dan Nguyen, Zhuxuan Fu, Philip G Jones, Harmony R Reynolds, Sripal Bangalore, Balram Bhargava, Roxy Senior, Ahmed Elghamaz, Shaun G Goodman, Renato D Lopes, Radoslaw Pracoń, José López-Sendón, Aldo P Maggioni, Shun Kohsaka, Gregory A Roth, Harvey D White, Kreton Mavromatis, William E Boden, Fatima Rodriguez, Judith S Hochman, David J Maron","doi":"10.1161/CIRCOUTCOMES.123.010534","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results.</p><p><strong>Methods: </strong>We analyzed participants' disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions. The average effect of initial invasive versus conservative strategies on 1-year SAQ scores was estimated using Bayesian proportional odds regression and compared across regions.</p><p><strong>Results: </strong>Considerable regional variation in baseline health status was observed among 4617 participants (mean age=64.4±9.5 years, 24% women), with the mean SAQ summary scores of 67.4±19.5 in Eastern Europe participants (17% of the total), 71.4±15.4 in Asia-Pacific (18%), 74.9±16.7 in Central and South America (10%), 75.5±19.5 in Western Europe (26%), and 78.6±19.2 in North America (28%). One-year improvements in SAQ scores were greater in regions with lower baseline scores with initial invasive management (17.7±20.9 in Eastern Europe and 11.4±19.3 in North America), but similar in the conservative arm. Adjusting for baseline SAQ scores, similar health status benefits of an initial invasive strategy on 1-year SAQ scores were observed (ranging from 2.38 points [95% CI, 0.04-4.50] in North America to 4.66 points [95% CI, 2.46-6.94] in Eastern Europe), with an 88.3% probability that the difference in benefit across regions was <5 points.</p><p><strong>Conclusions: </strong>In patients with chronic coronary disease and moderate or severe ischemia, initial invasive management was associated with a consistent health status benefit across regions, with modest regional variability, supporting the international generalizability of health status benefits from invasive management of chronic coronary disease.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":null,"pages":null},"PeriodicalIF":6.2000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479829/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation-Cardiovascular Quality and Outcomes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCOUTCOMES.123.010534","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/20 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results.

Methods: We analyzed participants' disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions. The average effect of initial invasive versus conservative strategies on 1-year SAQ scores was estimated using Bayesian proportional odds regression and compared across regions.

Results: Considerable regional variation in baseline health status was observed among 4617 participants (mean age=64.4±9.5 years, 24% women), with the mean SAQ summary scores of 67.4±19.5 in Eastern Europe participants (17% of the total), 71.4±15.4 in Asia-Pacific (18%), 74.9±16.7 in Central and South America (10%), 75.5±19.5 in Western Europe (26%), and 78.6±19.2 in North America (28%). One-year improvements in SAQ scores were greater in regions with lower baseline scores with initial invasive management (17.7±20.9 in Eastern Europe and 11.4±19.3 in North America), but similar in the conservative arm. Adjusting for baseline SAQ scores, similar health status benefits of an initial invasive strategy on 1-year SAQ scores were observed (ranging from 2.38 points [95% CI, 0.04-4.50] in North America to 4.66 points [95% CI, 2.46-6.94] in Eastern Europe), with an 88.3% probability that the difference in benefit across regions was <5 points.

Conclusions: In patients with chronic coronary disease and moderate or severe ischemia, initial invasive management was associated with a consistent health status benefit across regions, with modest regional variability, supporting the international generalizability of health status benefits from invasive management of chronic coronary disease.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.

慢性冠状动脉疾病患者接受初始侵入性治疗与保守治疗后健康状况获益的国际差异:ISCHEMIA试验的启示。
研究背景ISCHEMIA试验(国际医疗和介入治疗健康效果比较研究)显示,与保守治疗相比,对慢性冠状动脉疾病和中度或重度缺血患者采取初始介入治疗策略可为其健康状况带来更多益处。了解这些益处在全球范围内是否存在差异对于支持在全球范围内采用这些结果非常重要:我们使用经过验证的 7 项西雅图心绞痛问卷(SAQ:差异大于 5 分则具有临床意义)分析了 6 个国际地区 37 个国家的参与者在基线和 1 年随访期间的疾病特异性健康状况。采用贝叶斯比例赔率回归法估算了初始侵入性策略与保守性策略对 1 年 SAQ 评分的平均影响,并对不同地区进行了比较:4617名参与者(平均年龄=64.4±9.5岁,24%为女性)的基线健康状况存在很大的地区差异,东欧参与者(占总数的17%)的平均SAQ总分为67.4±19.5分,亚太地区为71.4±15.4分(占总数的18%),中南美洲为74.9±16.7分(占总数的10%),西欧为75.5±19.5分(占总数的26%),北美为78.6±19.2分(占总数的28%)。在基线评分较低的地区,初始侵入性治疗一年后的SAQ评分改善幅度更大(东欧为17.7±20.9,北美为11.4±19.3),但保守治疗组的改善幅度相似。对基线SAQ评分进行调整后,观察到初始有创策略对1年SAQ评分的健康状况有相似的益处(从北美的2.38分[95% CI,0.04-4.50]到东欧的4.66分[95% CI,2.46-6.94]不等),88.3%的概率表明不同地区的益处差异是结论:对于患有慢性冠状动脉疾病和中度或重度缺血的患者,最初的有创治疗与各地区一致的健康状况获益相关,但地区差异不大,这支持了慢性冠状动脉疾病有创治疗的健康状况获益在国际上的普遍性:URL:https://www.clinicaltrials.gov;唯一标识符:NCT01471522。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Circulation-Cardiovascular Quality and Outcomes
Circulation-Cardiovascular Quality and Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
8.50
自引率
2.90%
发文量
357
审稿时长
4-8 weeks
期刊介绍: Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信