Temporal Change in the Remaining Life Expectancy in People Who Underwent Percutaneous Coronary Intervention
Lan Gao1, Dieu Nguyen1, Marj Moodie1
1Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
Insights
Percutaneous coronary intervention (PCI) in Australia showed stable remaining life expectancy for patients over a decade. However, a widened gap in life expectancy in 2014-2016 highlights the need for better coronary heart disease prevention and management post-PCI.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Economics
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary heart disease.
- Long-term survival benefits and life expectancy changes post-PCI in Australian cohorts require further investigation.
- Assessing quality-adjusted life years (QALYs) gained is crucial for understanding the overall impact of PCI.
Purpose of the Study:
- To evaluate the changes in remaining life expectancy for patients undergoing PCI in Australia over a ten-year period.
- To compare the life expectancy of post-PCI patients with the general Australian population.
- To estimate the quality-adjusted life years (QALYs) gained by patients after PCI.
Main Methods:
- Analysis of patient data from the Melbourne Interventional Group, divided into four 3-year periods from 2005 to 2016.
- Kaplan-Meier survival curves and parametric survival distributions were used to estimate overall survival and remaining life expectancy.
- Comparison of life expectancy and QALYs gained between post-PCI patients and the general Australian population.
Main Results:
- Remaining life expectancy for patients averaged 64.4 years at PCI remained relatively stable across the study periods, ranging from 17.25 to 18.39 years.
- Quality-adjusted life years (QALYs) gained showed a similar trend, ranging from 14.13 to 15.07.
- A notable widening of the gap in life expectancy between post-PCI patients and the general Australian population was observed in the 2014-2016 period.
Conclusions:
- While PCI has maintained life expectancy for patients, the widening disparity in recent years indicates a need for enhanced coronary heart disease prevention strategies.
- Improved post-PCI disease management is recommended to reduce residual mortality risk and further extend patient survival.
- The findings underscore the importance of ongoing monitoring and optimization of care pathways for patients undergoing percutaneous coronary intervention.
Abstract:
Whether percutaneous coronary intervention (PCI) is effective in improving long-term survival in an Australian PCI cohort remains unclear. We aimed to examine the change in the remaining life expectancy for patients who underwent PCI over the past decade. Patient data from the Melbourne Interventional Group were divided into four 3-year periods (2005 to 2007, 2008 to 2010, 2011 to 2013, and 2014 to 2016) for survival analysis. The primary outcome was time to death after PCI. Kaplan-Meier survival curves for overall survival were constructed to estimate the 5-year survival. To extrapolate the overall survival curve to the lifetime time horizon, 6 parametric survival distributions were fitted to the individual patient-level data against the Kaplan-Meier curve. The best fit distribution was selected based on goodness-of-fit statistics and expert opinion. The combination of annual mortality post-PCI from the parametric survival analysis and the background mortality by age informed the overall mortality rate. The life expectancy was compared with the general Australians. In addition, the utility weight of post-PCI patients was used to estimate the quality-adjusted life years gained. A total of 27,301 patients with a mean age of 64.4 ± 12 years were included. The base-case results showed that over the 4 time periods, the remaining life expectancy for patients aged 64.4 years on average at the time of PCI remained relatively stable except for period 4: 18.12 years (2005 to 2007), 17.56 years (2008 to 2010), 18.39 years (2011 to 2013), and 17.25 years (2014 to 2016), respectively. The quality-adjusted life years gained 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. In conclusion, the widened gap in life expectancy in post-PCI patients versus the general Australian over the 2014 to 2016 period suggests the need for improved implementation of prevention strategies for coronary heart disease. Enhanced disease management after PCI that lowers residual mortality risk is recommended to extend the survival of patients with coronary heart disease.
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