Invasive Medical Procedures to Live Better, Not Longer May Not Be Prudent for all Patients -- Couch Potatoes May Like it That Way

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 treatment for patients, said Harlan Krumholz, M.D., associate professor in the Departments of Cardiology and Epidemiology and Public Health at Yale School of Medicine.

“A treadmill won’t tell you a lot about how the patients feel about their lives,” said Krumholz, senior author of the study published in the American Heart Journal. “This becomes 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 65 and more than half were men. Almost half of the patients were obese. About one quarter of the patients had had 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 the non-invasive test results correlated with the patients’ view of their quality of life most of the time, but that the patients’ perceptions of their own health and physical functioning were quite different than what the test results showed in many cases.

“Improving blood flow to the heart may be physiologically the same for two patients, but have vastly different impact on their lives,” Krumholz said. “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. Another person 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.”

He said the findings highlight the importance of not strictly relying on tests to determine the impact of cardiac disease on patients’ lives.

“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 said.

The other authors of the study were Frans J. Th. Wackers, M.D., 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, both researchers at the School of Medicine; and Carlos Mendes de Leon, formerly a faculty member at Yale School of Medicine.