Aspects on Revascularization for Coronary Artery Disease -From a Patient, Health Care Provider and Societal Perspective

Abstract

Background: Balloon dilatation with related techniques (PCI) is well established for treatment of angina pectoris. New techniques, that may increase costs, have been developed with the aim of reducing the risk of recurrent stenosis and symptoms, restenosis. It has, however, not been defined what a restenosis means to the patient or what expectations patients in general have prior to investigation and treatment of coronary artery disease. Aims: To evaluate the effects increased usage of stents in association with PCI, what it means to the patient to have a restenosis and to collect patients´ expectations, perceptions and attitudes in connection to investigation for suspect coronary artery disease. Results: Increased use of stents in association with PCI resulted in fewer new revascularizations without influencing subsequent mortality or risk for acute myocardial infarction. The initial in-hospital costs increased but were unchanged in the long term, as were sick leaves. The patients´ perception of restenosis was dominated by the experience of “living with uncertainty”. With a newly developed questionnaire patients´ expectations, perceptions and attitudes prior to and after a planned coronary angiography were collected and compared with quality of life measured with established instruments. The majority of patients had high expectations before the health care process and a positive attitude to treatment, life style changes and to be involved in the health care process. The expectations were, however, six months later fulfilled to a lower degree. Those who had their expectations fulfilled had higher quality of life and improvement in quality of life than those who did not have their expectations fulfilled.