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European Heart Journal Advance Access published online on May 22, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl038
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received July 14, 2005
Revised March 31, 2006
Accepted April 28, 2006

Clinical research

Quality of life after coronary revascularization in the elderly

Michelle M. Graham 1 *, Colleen M. Norris 2, P. Diane Galbraith 3, Merril L. Knudtson 4, William A. Ghali 5, and APPROACH Investigators 6

1 Division of Cardiology, Department of Medicine, University of Alberta Hospital, 8440-112 Street, Edmonton, Alberta, Canada T6G 2R7
2 Division of Cardiology, Department of Medicine, University of Alberta Hospital, 8440-112 Street, Edmonton, Alberta, Canada T6G 2R7; Faculty of Nursing, University of Alberta, Alberta, Canada
3 Centre for Health and Policy Studies, University of Calgary, Calgary, Canada
4 Department of Medicine, University of Calgary, Calgary, Canada; The Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
5 Department of Medicine, University of Calgary, Calgary, Canada; Community Health Sciences, University of Calgary, Calgary, Canada; Centre for Health and Policy Studies, University of Calgary, Calgary, Canada
6 APPROACH Project Office (PDG), Calgary, Edmonton, Canada

* To whom correspondence should be addressed.
Michelle M. Graham, E-mail: mmgraham{at}cha.ab.ca


  Abstract

Aims To describe health status outcomes at 4 years for a cohort of elderly patients with cardiac disease.

Methods and results Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, an outcomes initiative capturing all patients undergoing cardiac catheterization in Alberta, Canada, health status was measured using the Seattle Angina Questionnaire (SAQ) and crude and risk-adjusted outcomes were determined and compared for patients treated with percutaneous coronary intervention or coronary artery bypass surgery (CABG) vs. medical therapy. Response rates among surviving, consenting patients were 64.8% for patients <70 years (n=7883), 77.3% for patients aged 70-79 years (n=2940), and 77.7% for patients ≥80 years of age (n=439). For patients aged <70 years, and those aged 70-79 years, for all dimensions of the SAQ, scores were significantly better for patients treated with revascularization procedures than with medical therapy. For patients over the age of 80 years, scores for patients treated with CABG in particular were significantly better, with the exception of exertional capacity. At 3 years, all scores remained stable or improved, and continued to favour revascularization.

Conclusion Elderly patients undergoing revascularization have better health status at 4 years than do those in the same age group who do not undergo revascularization. These findings suggest that age should not deter against revascularization given the combined survival and quality-of-life benefits.

Keywords: Aging; Revascularization; Coronary disease; Morbidity.
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