of patients' needs, says cardiologist
Treadmill and other tests to determine exercise capacity and blood flow to the heart may not provide accurate information about a patient's quality of life, a study by Yale researchers shows.
These findings are important because these test results are often used to make decisions about clinical strategies for patients, says Dr. Harlan Krumholz, associate professor of cardiology and of epidemiology and public health at the School of Medicine.
"A treadmill won't tell you a lot about how the patients feel about their lives," says Krumholz, senior author of the study published in the American Heart Journal. "This becomes very important because so many of the interventions in cardiology, such as angioplasty, are meant to help the patient live better, rather than to live longer. You have to talk to patients and see what their goals are."
The researchers evaluated 195 patients referred from 1993 to 1995 for detection of coronary artery disease and evaluation of myocardial ischemia, which is impaired blood flow to the heart. About one quarter of the patients were age 65, and more than half were men. Almost half of the patients were obese. About one quarter of the patients had suffered a heart attack and prior revascularization.
The researchers compared the results of the patients' diagnostic tests -- exercise electrocardiogram treadmill testing and myocardial perfusion imaging -- with the patients' own view of their physical functioning and general health perception as determined from a questionnaire.
The researchers found that, on average, the non-invasive test results correlated with the patients' view of their quality of life, but that individually, the patients' perceptions of health and physical functioning were often quite different than what the test results showed.
"Improving blood flow to the heart may be physiologically the same for two patients, but have vastly different impacts on their lives," Krumholz says. "For patients who are limited by their chest pain and feel unable to do the activities that are important to them, a decrease in chest pain may have dramatic effect on their quality of life. Other people may do relatively little physical activity because of their lifestyle and the same degree of chest pain with exertion may not be limiting them in any important way."
The findings highlight the importance of not strictly relying on tests to determine the impact of cardiac disease on patients' lives, he says.
"In an era of technological innovation, it is easy to lose sight of the importance of listening to patients and understanding the impact of their disease from their perspective," Krumholz notes.
The other authors of the study were Dr. Frans J. Th. Wackers, professor of diagnostic radiology and cardiology; Jennifer Mattera, director of the Center for Outcomes Research at Yale-New Haven Hospital; Yongfei Wang and Christianna Williams, researchers at the School of Medicine; and Carlos Mendes de Leon, formerly a faculty member at Yale School of Medicine.
-- By Jacqueline Weaver
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