Interventional cardiology

Life expectancy gap widens in post-PCI patients

A study of life expectancy post-PCI in Australia has shown a drop in survival during 2014-2016 compared to previous time periods.

Data from 27,301 patients in the Melbourne Interventional Group registry were divided into four 3-year periods (2005-2007, 2008-2010, 2011-2013, and 2014-2016), linked to the Australian National Death Index, and used to estimate life expectancy post-PCI.

Patients had a mean age of 64.4 ± 12 years and were mostly male (76.5%).

The study, published in the American Journal of Cardiology [link here], found the remaining life expectancy for patients aged 64.4 at the time of PCI was relatively stable across the first three time periods (18.12, 17.56 and 18.39 years respectively) but then fell to its lowest at 17.25 years in the fourth period.

The quality-adjusted life-years (QALYs) showed a similar trend: 14.86 (2005 to 2007), 14.40 (2008 to 2010), 15.07 (2011 to 2013), and 14.13 (2014 to 2016) separately.

When compared with that of the general Australian population, the study found the predicted life expectancy post-PCI was generally lower, particularly in period 4.

“For patients who had an index PCI between 2005 and 2007, the life expectancy was 18.1 for post-PCI patients versus 20.9 for the general population. Similarly, patients who had a PCI between 2014 and 2016 were predicted to have 17.25 life years remaining, while the life expectancy was 21.8 for the general population during the same time period,” the study said.

“The seemingly increased number of PCI procedures performed in period 4 and decreased survival compared with period 1 may suggest that CHD prevention (primary and secondary) strategies may need an improved implementation in Australia, indicated by unmodified risk factors over the years.”

It said the findings were consistent with international studies.

The investigators, led by health economist Dr Lan Gao from the Institute for Health Transformation at Deakin University, said the temporal change related to life expectancy and QALY post-PCI might suggest a shift in the composition of patient cohorts over time.

“For example, period 4 (2014 to 2016) had more patients with LVEF <60% (or fewer patients with LVEF >60%),” they said.

They also noted that reperfusion therapy has evolved significantly over time.

“Enhanced disease management after PCI that lowers residual mortality risk is recommended to extend the survival of patients with coronary heart disease,” they concluded.

“Our study results have policy relevance for the future cost-effectiveness analysis in CHD. It is now increasingly required that new interventions demonstrate cost-effectiveness (the extra benefits should justify the additional costs associated with new health technology).

“Particularly for CHD, new interventions like new pharmaceuticals to prevent secondary events or new health services promoting treatment adherence after PCI will need to establish the cost-effectiveness of such intervention.”

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