Elsevier

American Heart Journal

Volume 162, Issue 3, September 2011, Pages 501-506
American Heart Journal

Clinical Investigation
Outcomes, Health Policy, and Managed Care
Altered health status and quality of life in South Asians with coronary artery disease

https://doi.org/10.1016/j.ahj.2011.06.009Get rights and content

Background

People of South Asian (SA) ancestry are susceptible to coronary artery disease (CAD). Although studies suggest that SA with CAD has a worse prognosis compared with Europeans, it is unknown whether corresponding differences in functional status and quality-of-life (QOL) measures exist. Accordingly, we compared symptoms, function, and QOL in SA and European Canadians with CAD using the Seattle Angina Questionnaire (SAQ).

Methods

Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, an outcomes registry that captures patients undergoing cardiac catheterization in Alberta, Canada, we identified 635 SA and 18,934 European patients with angiographic CAD from January 1995 to December 2006 who reported health status outcomes using the SAQ at 1 year after the index catheterization. To obtain comparable clinical variables among SA and Europeans, we used a propensity score–matching technique.

Results

One-year adjusted mean (SD) scores were significantly lower in SA compared with European Canadians for most SAQ domains: exertional capacity (75 [23] vs 80 [23], P = .011), anginal stability (77 [28] vs 77 [27], P = .627), anginal frequency (86 [23] vs 88 [20], P < .001), treatment satisfaction (86 [19] vs 89 [16], P < .001), and SAQ QOL (71 [24] vs 76 [21], P < .001). These results could not be accounted for by differences in baseline QOL scores or changes in health status from baseline to 1 year.

Conclusion

South Asian Canadians with established CAD have significantly worse health status outcomes at 1 year after angiography compared with European Canadians. Further studies are warranted to improve functional outcomes in SA with CAD.

Section snippets

Data source

The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) is a prospective clinical data collection initiative capturing all patients undergoing cardiac catheterization and revascularization in the province of Alberta, Canada, since 1995. The registry contains detailed clinical information including patient's age; sex; ejection fraction; and the presence or absence of previous myocardial infarction, congestive heart failure, cerebrovascular disease, peripheral

Results

After excluding patients of Chinese descent, a total of 49,456 patients with established angiographic CAD (>50% stenosis) were identified from January 1995 to December 2006 (Figure 1). Of these, 2,168 patients were of SA decent, and 47,288 patients were of European ancestry. Because of deaths and refusal of consent, there were 1,612 eligible SA patients and 34,252 eligible European patients. Of these, patients who responded with 1-year SAQ results were included in our study, leaving 635 SA and

Discussion

Health-related QOL has been increasingly used as a measure of health-related outcome including major end points in large clinical trials. Consequently, there has been a shift in treatment of CAD focusing on not only enhanced survival but also on improvement of ischemic symptoms and overall functional levels.14, 15, 16 Using the easily accessible SAQ, a research tool whose effectiveness in documenting changes in HRQOL outcomes in patients with CAD is well established, we were able to show that

Disclosures

This work was supported by Approach, which has funded in 1995 by the Weston Foundation, with ongoing support from Merck Frosst Canada, Inc; Monsanto Canada, Inc, Searle Eli Lilly Canada, Inc; Guidant Corporation; Boston Scientific Ltd; Hoffmann-La Roche Ltd; Johnson & Johnson, Inc, Cordis; and the Province-Wide Services Committee of Alberta Health and Wellness.

Acknowledgements

We appreciate the assistance of the Calgary Health Region and the Capital Health Authority in supporting data entry by cardiac catheterization laboratory personnel. Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease receives support from industry sponsors. C.M.N. is supported by a New Investigators Award from Canadian Institute of Health Research and a Population Health Investigators Award from the Alberta Heritage Foundation for Medical Research.

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