Extra 'STICH' in bypass adds no benefit to quality of life

March 28, 2009

DURHAM, NC - A surgical procedure to resize an enlarged, weakened heart muscle during coronary bypass surgery for heart failure adds cost and risk but doesn't offer patients any additional benefit when compared with those who received bypass procedure alone, according to researchers from the Duke Clinical Research Institute (DCRI).

Duke researchers examined quality of life and cost issues among 1000 patients with heart failure enrolled in the STICH trial (Surgical Treatment for Ischemic Heart Failure), a multi-center, international clinical trial that compared clinical outcomes between patients who had bypass surgery alone with those who had bypass combined with a second procedure, called surgical ventricular reconstruction (SVR).

Surgical ventricular reconstruction has been added to coronary bypass surgery for nearly 25 years in selected patients with heart failure. The procedure involves removing dead or damaged sections of the front wall of the heart and reshaping the left ventricle to create a more normally-sized, stronger heart that can beat more efficiently.

The primary results from the STICH trial, also being reported at the American College of Cardiology's 58th Annual Scientific Session, showed that SVR offered no additional benefit in terms of reduced death or cardiac hospitalization, the primary endpoints of the study.

In a separate part of the study, researchers also compared quality of life and cost outcomes in the two treatment arms of the STICH trial.

Led by Daniel Mark, M.D., Director of Outcomes Research at the DCRI, researchers used the Kansas City Cardiomyopathy Questionnaire and other specialized instruments to evaluate various aspects of patients' lives for up to three years after their surgery. Researchers also collected resource use and cost data on 196 patients who were enrolled in the trial in the United States.

After reviewing all the data, researchers found that members of both treatment groups improved substantially post-operatively, but they did not find any significant differences between the two groups' quality of life measures. They also discovered that hospitalization costs averaged over $14,500 higher for patients who received SVR in addition to bypass, mostly due to 4.2 extra days of high-intensity post-operative care in the hospital.

"The take home message is that coronary bypass surgery in this population substantially improves functioning and quality of life, but adding SVR does not provide any further improvement over that provided by bypass alone," says Mark. "However, adding SVR substantially increased the cost of the operation, so we can't see any justification for routine use of this option in patients with heart failure who need bypass surgery."

"The STICH trial illustrates how comparative effectiveness studies benefit physicians, patients and the overall health care system," says Kevin Anstrom, Ph.D., lead statistician of the quality of life study. "This trial compared two therapies for the same malady and found that the riskier, more expensive treatment did not improve patients' survival or quality of life. These findings can help save health care resources while maintaining quality of care."
-end-
The National Heart, Lung, and Blood Institute funded the study, which will also appear online Monday in the American Heart Journal.

Additional investigators from Duke who contributed to the study include David Knight, Tina Harding and Laura Drew, from the Outcomes Research Group; and Eric Velazquez and Gena Rankin, from DCRI. Additional co-authors include Jonathan Howlett, from the University of Calgary; John Spertus, from the Mid America Heart Institute; Ljubomir Djokovic, of the Dedinje Cardiovascular Institute, Belgrade; Bozena Szygula-Jurkiewicz, from the Silesian Center for Heart Disease, Poland; and Christopher Adlbrecht from the Medical University of Vienna.

Dr. Mark will present details of the STICH QOL study at 11:38 a.m, Tuesday, March 31, as part of an ACC Late-Breaking Clinical Trials presentation in (Hall A2) at the Orange County Convention Center.

Duke University Medical Center

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.