Skip to main content
SpringerLink
Log in

Defining Outcomes in Older Patients with Cardiovascular Disease

  • Leading Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Summary

It is now possible to track a comprehensive range of outcomes in elderly cardiac patients. Beside vital clinical end-points, these include health-related quality of life, satisfaction with care, and economic outcomes. This range of outcomes, each set complementing the others, can support patient care that is more effective from both the physician’s and the patient’s perspective. In this summary article, quality of life, satisfaction and economic outcomes are explored relative to the treatment of elderly cardiac patients. This is not meant to diminish the importance of the clinical measures that can and must be readily appreciated by physicians managing their cardiac patients. Instead, the measures discussed here augment the armamentarium that physicians can use to implement their patient care responsibilities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cleary PD, Greenfield S, McNeil BJ. Assessing quality of life after surgery. Control Clin Trials 1991; 12 Suppl.: 189S–203S

    Article  PubMed  CAS  Google Scholar 

  2. Guadagnoli E, Ayanian JZ, Cleary PD. Comparison of patient-reported outcomes after elective coronary artery bypass grafting in patients aged ≽ and < 65 years. Am J Cardiol 1992; 70: 60–4

    Article  PubMed  CAS  Google Scholar 

  3. Cleary PD, Epstein AM, Oster G, et al. Health-related quality of life among patients undergoing percutaneous transluminal coronary angioplasty [published erratum appears in Med Care 1992; 30: 76]. Med Care 1991; 29: 939–50

    Article  PubMed  CAS  Google Scholar 

  4. Sjoland H, Wiklund I, Caidahl K, et al. Improvement in quality of life and exercise capacity after coronary bypass surgery. Arch Intern Med 1996; 156: 265–71

    Article  PubMed  CAS  Google Scholar 

  5. Tarlov AR, Ware Jr JE, Greenfield S, et al. The Medical Outcomes Study: an application of methods for monitoring the results of medical care. JAMA 1989; 262: 925–30

    Article  PubMed  CAS  Google Scholar 

  6. Nease RF, Kneeland T, O’Connor GT, et al. Variation in patient utilities for outcomes of the management of chronic stable angina: implications for clinical practice guidelines. JAMA 1995; 273: 1185–90

    Article  PubMed  Google Scholar 

  7. Stewart AL, Hays RD, Ware Jr JE. The MOS short-form general health survey: reliability and validity in a patient population. Med Care 1988; 26: 724–35

    Article  PubMed  CAS  Google Scholar 

  8. Jette AM, Davies AR, Cleary PD, et al. The Functional Status Questionnaire: reliability and validity when used in primary care [published erratum appears in J Gen Intern Med 1986; 1: 427]. J Gen Intern Med 1986; 1: 143–9

    Article  PubMed  CAS  Google Scholar 

  9. Bergner M, Bobbitt RA, Carter WB, et al. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981; 19: 787–805

    Article  PubMed  CAS  Google Scholar 

  10. Kaplan RM, Anderson JP, Wu AW, et al. The Quality of Well-Being Scale: applications in AIDS, cystic fibrosis, and arthritis. Med Care 1989; 27 Suppl.: S27–43

    Article  PubMed  CAS  Google Scholar 

  11. Guadagnoli E, Hauptman PJ, Ayanian JZ, et al. Variation in the use of cardiac procedures after acute myocardial infarction. N Engl J Med 1995; 333: 573–8

    Article  PubMed  CAS  Google Scholar 

  12. Rose GA, Blackburn H. Cardiovascular survey methods. World Health Organization monograph series no. 56. Geneva: WHO, 1968

    Google Scholar 

  13. Goldman L, Hashimoto B, Cook EF, et al. Comparative repro-ducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation 1981; 64: 1227–34

    Article  PubMed  CAS  Google Scholar 

  14. Oldridge N, Guyatt G, Jones N, et al. Effects on quality of life with comprehensive rehabilitation after acute myocardial infarction. Am J Cardiol 1991; 67: 1084–9

    Article  PubMed  CAS  Google Scholar 

  15. Hillers TK, Guyatt GH, Oldridge N, et al. Quality of life after myocardial infarction. J Clin Epidemiol 1994; 47: 1287–96

    Article  PubMed  CAS  Google Scholar 

  16. Lim LL-Y, Valenti LA, Knapp JC, et al. A self-administered quality-of-life questionnaire after acute myocardial infarction. J Clin Epidemiol 1993; 46: 1249–56

    Article  PubMed  CAS  Google Scholar 

  17. Guyatt GH, Nogradi S, Halcrow S, et al. Development and testing of a new measure of health status for clinical trials in heart failure. J Gen Intern Med 1989; 4: 101–7

    Article  PubMed  CAS  Google Scholar 

  18. Guyatt GH. Measurement of health-related quality of life in heart failure. J Am Coll Cardiol 1993; 22 Suppl. A: 185A–91A

    Article  PubMed  CAS  Google Scholar 

  19. Rector TS. Outcome assessment: functional status measures as therapeutic endpoints for heart failure. Top Hosp Pharm Manage 1990; 10: 37–43

    PubMed  CAS  Google Scholar 

  20. Tandon PK, Stander H, Schwarz Jr RP Analysis of quality of life data from a randomized, placebo-controlled heart failure trial. J Clin Epidemiol 1989; 42: 955–62

    Article  PubMed  CAS  Google Scholar 

  21. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes. JAMA 1995; 273: 59–65

    Article  PubMed  CAS  Google Scholar 

  22. Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry 1988; 25: 25–36

    PubMed  CAS  Google Scholar 

  23. Iglehart JK. The National Committee for Quality Assurance. N Engl J Med 1996; 335: 995–9

    Article  PubMed  CAS  Google Scholar 

  24. Gurwitz JH, Col NF, Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA 1992; 268: 1417–22

    Article  PubMed  CAS  Google Scholar 

  25. McClellan M, McNeil BJ, Newhouse JP. Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality? Analysis using instrumental variables. JAMA 1994; 272: 859–66

    Article  PubMed  CAS  Google Scholar 

  26. Lamas GA, Pashos CL, Normand ST, et al. Permanent pacemaker selection and subsequent survival in elderly Medicare pacemaker recipients. Circulation 1995; 91: 1063–9

    Article  PubMed  CAS  Google Scholar 

  27. Stone RP, Thompson B, Anderson HV, et al. Influence of race, sex, and age on management of unstable angina and non-Q wave myocardial infarction: the TIMI III registry. JAMA 1996; 275: 1104–12

    Article  PubMed  CAS  Google Scholar 

  28. Pashos CL, Newhouse JP, McNeil BJ. Temporal changes in the care and outcomes of elderly patients with acute myocardial infarction, 1987 through 1990. JAMA 1993; 270: 1832–6

    Article  PubMed  CAS  Google Scholar 

  29. Oster G, Epstein AM. Cost-effectiveness of antihyperlipemic therapy in the prevention of coronary heart disease: the case of cholestyramine. JAMA 1987; 258: 2381–7

    Article  PubMed  CAS  Google Scholar 

  30. Goldman L, Weinstein MC, Goldman PA, et al. Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease. JAMA 1991; 265: 1145–51

    Article  PubMed  CAS  Google Scholar 

  31. Krumholz HM, Pasternak RC, Weinstein MC, et al. Cost-effectiveness of thrombolytic therapy with streptokinase in elderly patients with suspected acute myocardial infarction. N Engl J Med 1992; 327: 7–13

    Article  PubMed  CAS  Google Scholar 

  32. Midgette AS, Wong JB, Beshansky JR, et al. Cost-effectiveness of streptokinase for acute myocardial infarction: a combined meta-analysis and decision analysis of the effects of infarct location and of likelihood of infarction. Med Decis Making 1994; 14: 108–17

    Article  PubMed  CAS  Google Scholar 

  33. Goldman L, Sia STB, Cook EF, et al. Costs and effectiveness of routine therapy with long-term beta-adrenergic antagonists after acute myocardial infarction. N Engl J Med 1988; 319: 152–7

    Article  PubMed  CAS  Google Scholar 

  34. Van Bergen PFMM, Jonker JJC, van Hout BA, et al. Costs and effects of long-term oral anticoagulant treatment after myocardial infarction. JAMA 1995; 273: 925–8

    Article  PubMed  Google Scholar 

  35. Kuntz KM, Tsevat J, Goldman L, et al. Cost-effectiveness of routine coronary angiography after acute myocardial infarction. Circulation 1996; 94: 957–65

    Article  PubMed  CAS  Google Scholar 

  36. Lee TH, Fukui T, Weinstein MC, et al. Cost-effectiveness of screening strategies for left main coronary artery disease in patients with stable angina. Med Decis Making 1988; 8: 268–78

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abt Associates Inc., 55 Wheeler Street, Cambridge, Massachusetts, 02138, USA

    Chris L. Pashos

  2. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA

    Chris L. Pashos

Authors
  1. Chris L. Pashos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chris L. Pashos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pashos, C.L. Defining Outcomes in Older Patients with Cardiovascular Disease. Drugs & Aging 10, 243–248 (1997). https://doi.org/10.2165/00002512-199710040-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199710040-00001

Keywords

Search

Navigation