Quality of life of patients with chronic stable angina before and four years after coronary revascularisation compared with a normal population.

OBJECTIVE: To assess the impact of coronary revascularisation on the health related quality of life (HRQOL) of patients with chronic stable angina compared with data from "community" norms four years following revascularisation. DESIGN: Prospective survey and review of medical records. SETTING: Seven of the eight public Swedish heart centres that performed coronary artery interventions. SUBJECTS: 827 patients aged 55-79 years with chronic stable angina who underwent coronary artery revascularisation in 1994 or 1995 and completed the four year HRQOL survey. MAIN OUTCOME MEASURES: Five components of the Swedish quality of life survey. RESULTS: Compared with age and sex adjusted population norms, patients at baseline had significantly lower mean scores on all five functioning and wellbeing scales (p < 0.001). Four years after revascularisation, the mean levels of functioning and wellbeing were similar to those in the normative population (p > 0.05) except for quality of sleep (p < 0.001). The improvements were the same across age groups and for men and women. However, 36% of men and 55% of women were not completely free from angina by four years (p < 0.001). Men without angina after four years had better HRQOL than their community norms (p < 0.001) on all dimensions except quality of sleep (p > 0.05). Women without angina had less pain (p < 0.01) and better general health perception (p < 0.05) but similar physical functioning, quality of sleep, and emotional wellbeing compared with their community counterparts. Both men and women who had suffered at least one anginal attack during the preceding four weeks had significantly worse HRQOL by four years than their community norms (p < 0.01). CONCLUSIONS: By four years following revascularisation, three fifths of patients with chronic stable angina were free of angina and their HRQOL was the same as or better than that of the general Swedish population. However, fewer than half of all women and two thirds of men who underwent revascularisation were angina-free after four years. Among patients with new or persistent angina, the HRQOL was worse than that in community norms.

Quality of life of chronic stable angina patients 4 years after coronary angioplasty or coronary artery bypass surgery.

OBJECTIVE: To evaluate the quality of life experienced by chronic stable angina patients with one- or two-vessel coronary artery disease treated with percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG). DESIGN: Prospective survey and review of medical records. PATIENTS: Consecutive series of 601 Swedish chronic stable angina patients with one- or two-vessel disease who underwent CABG (n = 252) or PTCA (n = 349) between May 1994 and January 1995. MAIN OUTCOME MEASURES: We assessed five components of the Swedish Quality of Life Survey, anginal frequency, sublingual nitroglycerin use, and survival at 6, 21 and 48 months following coronary revascularization. RESULTS: Anginal frequency and sublingual nitroglycerin use decreased for all patients by 6 months, but more amongst surgery patients than amongst angioplasty patients (P < 0.05). At 48 months, more bypass patients reported that they had not used sublingual nitroglycerin during the preceding 4 weeks (73.1 vs. 63.4%, P < 0.05). At 6 months, bypass patients had greater levels of improvement in physical functioning (15.3 vs. 10.5, P < 0.05) and general health perception (16.5 vs. 10.2, P < 0.05) than angioplasty patients. Bypass patients also had better relief from pain (19.4 vs. 14.6, P < 0.05), quality of sleep (17.6 vs. 4.6, P < 0.05) and general health perception (17.3 vs. 12.1, P < 0.05) at 21 months. By 48 months follow-up, there was no longer any difference in these measures between groups. CONCLUSIONS: Both bypass surgery and angioplasty lead to improved quality of life for patients with chronic stable angina and one- or two-vessel coronary artery disease. Bypass surgery is associated with better quality of life at 6 months, but by 48 months quality of life is similar for patients initially treated by either procedure.

[Swedish research in hypertension]. / Den tidiga hypertoniforskningen i Sverige - en medicinhistorisk översikt.

In Sweden, research in hypertension has been on-going since the early 1920's when Eskil Kylin was the first to describe hypertension as part of a metabolic cardiovascular syndrome. Later on several other researchers and clinicians have contributed to the development of medical understanding of hypertension and its treatment. Bertil Hood was the one who started modern drug therapy for malignant hypertension in 1950 when hexamethonium was used, which was a life-saving drug but with many serious adverse reactions. Later on other drugs have been developed many of them first tested in smaller haemodynamic studies before used in clinical trials. Some of these smaller studies were initiated by Lars Werkö and his colleagues. In recent years Swedish researchers have made great contributions in hypertension research, e.g. Björn Folkow for studies regarding arterial wall modelling in hypertension, and Lennart Hansson for initiating large-scale randomised clinical trials in middle-aged and elderly hypertensive patients. In spite of the fact that hypertensive patients constitute the largest patient group of all, with currently 700.000 treated patients in Sweden, it is still not well established which therapy and other interventions are the most beneficial and cost-effective for long-term treatment. Swedish research in hypertension is therefore ongoing and supported by the Swedish Hypertension Society for which Peter Nilsson is the current patient.

Health technology assessment in Sweden.

Sweden has a welfare system that is based on the fundamental principle that all citizens are entitled to good health and medical care, regardless of where they live or what their economic circumstances are. Health and medical care are considered to be public sector responsibilities. However, there is growing interest in establishing more private alternatives to public care. An important characteristic of the Swedish healthcare system is its decentralization, with a major role for county councils. County councils are now merging into larger administrative units (region). The whole Swedish system is in the process of reform, mainly because of perceptions that it was too rigid and had insufficient patient orientation. An important factor in the reforms is that power in the system will be even more decentralized and will have greater public input. This change is seen as calling for increased central follow-up and evaluation of matters such as social, ethical, and economic aspects. Although the state has decentralized control, it still attempts to control the general direction of the system through regulation, subsidy, recommendations, and guidelines. An important actor in the system is the Swedish Council on Technology Assessment in Health Care (SBU). SBU began in 1987 with assessments of health technologies, but its success has recently led policy makers to extend its coverage to dental care. Health technology assessment is increasingly visible to policy makers, who find it useful in decision making.