Publications by authors named "M D Flather"
Should we routinely measure patient quality of life after acute coronary syndrome?
Eur Heart J Qual Care Clin Outcomes
November 2024
Article Synopsis
- Percutaneous active mechanical circulatory support (MCS) devices are increasingly used for treating acute myocardial infarction-related cardiogenic shock (AMICS), but there is mixed evidence on their impact on patients' mortality rates.
- This study conducted an individual patient data meta-analysis of randomised controlled trials to assess the effect of early routine active MCS versus control treatments on 6-month all-cause mortality in AMICS patients.
- The analysis included nine studies with a total of 1114 patients and found that four trials evaluated venoarterial extracorporeal membrane oxygenation (VA-ECMO) while five focused on left ventricular unloading devices, contributing valuable insights into their effectiveness in this patient group.
Background: Whether a conservative strategy of medical therapy alone or a strategy of medical therapy plus invasive treatment is more beneficial in older adults with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear.
Methods: We conducted a prospective, multicenter, randomized trial involving patients 75 years of age or older with NSTEMI at 48 sites in the United Kingdom. The patients were assigned in a 1:1 ratio to a conservative strategy of the best available medical therapy or an invasive strategy of coronary angiography and revascularization plus the best available medical therapy.
Article Synopsis
- A recent meta-analysis found that routine veno-arterial ECMO (VA-ECMO) does not improve outcomes for patients with acute myocardial infarction-related cardiogenic shock (AMI-CS), while a specific microaxial flow pump did lower mortality in a certain patient group.
- Individual patient data from four randomized trials were analyzed, focusing on patients similar to those in the DanGer-Shock trial, which aimed at understanding the 180-day all-cause mortality rates with VA-ECMO.
- Despite a numerically lower 6-month mortality rate with VA-ECMO (45% vs. 51% in control), the risks of major bleeding and peripheral vascular complications were higher, suggesting no clear mortality benefit in this population.
Article Synopsis
- The article investigates minimal clinically important differences (MCIDs) in quality of life (QoL) for patients who underwent coronary artery bypass grafting (CABG) within the arterial revascularization trial (ART).
- It uses quality of life measures such as the EQ-5D and SF-36 scores taken at baseline, 5 years, and 10 years post-surgery, finding significant improvements in QoL after CABG.
- The identified MCIDs are linked to lower mortality risks long term, suggesting their importance for patient monitoring and clinical trial design.