Initial functional and economic status of patients with multivessel coronary artery disease randomized in the Bypass Angioplasty Revascularization Investigation (BARI)

Abstract

Randomized trials of coronary angioplasty and bypass surgery have hypothesized that these procedures will have equivalent long-term rates of death and myocardial infarction. Functional status, quality of life, employment, and healthcare cost will therefore be critical measures of the efficacy of these alternative revascularization procedures. Patients at 7 sites in the Bypass Angioplasty Revascularization Investigation (BARI) were enrolled in an ancillary Study of Economics and Quality of Life (SEQOL). Physical function was assessed by the Duke Activity Status Index and emotional status by the Mental Health Inventory. Employment patterns and health care utilization were also measured at study entry and at 3-month intervals in follow-up. The 934 patients enrolled in SEQOL were similar to the 895 remaining BARI randomized patients. Most patients (63%) aged < or = 64 years were working, and almost all working patients (96%) intended to return to work. Patients aged > or = 65 years had lower household incomes but better health insurance coverage. Overall health ratings were significantly correlated with both physical and emotional status (p < 0.001). Patients enrolled in SEQOL are representative of the overall BARI population. Data collected in SEQOL will provide a detailed picture of the physical, emotional, and economic well-being after coronary angioplasty and bypass surgery.

Comparing Interventions in Older Unpartnered Adults after Myocardial Infarction

“…The high attrition rate and the less than optimal level of recovery behaviors at baseline, identified by the low scores on the DASI, may have affected the receipt and actual enactment of the measured recovery behaviors. Other researchers have reported mean scores on the DASI of 20–36 in cardiovascular populations between the ages of 60–76 years while in this study the mean DASI score was 16.7 at baseline [28–30]. These older adults may not have received or performed requested activities due to physical limitations, limiting the effect of this intervention on recovery behavior.…”

The Effect of Major Depression on Functional Status in Patients with Coronary Artery Disease

“…In addition to longitudinal studies of depression and functional status, research is also needed on the effect of depression in CAD patients on health‐related outcomes including quality of life, cost, and healthcare utilization. Such studies have included brief measures of mental health status, 29,30 but our data suggest that information on presence and course of major depression should be part of comprehensive assessment in health services research. Clinicians should also be encouraged to further explore reported depressive symptoms, which they may perceive to be common in CAD patients: those with major depression may have significant disability.…”

Comparison of Coronary Bypass Surgery with Angioplasty in Patients with Multivessel Disease

“…Screening results and base-line characteristics of randomized and registry patients have been published elsewhere. [10][11][12][13][14] Randomization was carried out with the use of blocks of varying length, with stratification only according to clinical center. Computers provided to the clinical centers were used to decode the encrypted assignments to ensure that treatment remained blinded until randomization.…”