Tuesday, March 31, 2009

Late-breaking clinical trial: STICH finds no added quality of life improvement
By Kelly Winget, DCRI Communications

One option for cardiologists treating patients with heart failure who need coronary bypass surgery is to also perform an additional procedure to resize the weakened heart muscle.

But a new study led by DCRI researchers found that the additional procedure increases a patient's risk as well as the cost of care but doesn't provide quality of life benefits over just having the bypass surgery.

The DCRI's Dan Mark, MD, MPH, director of Outcomes Research, presented the findings Tuesday, March 31 at a late-breaking clinical trial session at the American College of Cardiology Annual Scientific Session.

The trial, STICH (Surgical Treatment for Ischemic Heart Failure), included a clinical study as well as an Economics and Quality of Life study, which analyzed the quality of life and health care costs for patients who underwent just coronary bypass surgery or bypass surgery and ventricular reconstruction. The DCRI's Robert Jones, MD, presented clinical findings from STICH on Sunday, March 29.

Bypass surgery grafts a new artery or vein around diseased coronary arteries and then reroutes blood flow to the heart through the new artery or vein. For patients who have heart failure, their hearts can become enlarged as the heart tries to pump more blood, but the stretching weakens the heart, which is why vascular reconstruction has been used for some heart failure patients. The procedure removes damaged sections and reshapes the left ventricle of the heart to be a more normal size.

Researchers enrolled 1,000 patients with heart failure and followed them for up to three years after they had the surgery or the surgery and reconstruction procedure. The study results indicated that the additional reconstruction did not lower the risk of death or decrease the likelihood of needing to be hospitalized due to cardiac problems.

When analyzing quality of life aspects and cost differences between the two groups of patients, researchers found the quality of life measures were very similar in both groups. However, the patients who had the reconstruction in addition to the bypass surgery had an average of $14,500 higher hospitalization costs and needed to stay in the hospital an average of an additional four days.

Other DCRI researchers involved in the study were Kevin Anstrom, PhD, Linda Davidson-Ray, David Knight, and Tina Harding, RN, BSN.