Key result
Invasive strategy yields a modest ~1-point SAQ gain over conservative care, concentrated in frequent angina.
Why the study?
The relationship between exercise capacity and patients' daily physical and social activities in stable coronary heart disease was unclear.
RCT (n=1,819)
Open-label
Yes
Yes
Mean Difference: 1.4 (95% CI 0.2–2.5)
Small SAQ benefit from invasive strategy in stable CAD does not support routine use; leaves open targeted trials in frequent-angina subgroups.
• We studied 100 men with clinically stable coronary heart disease. Their capacity for exertion as defined by treadmill test was compared with the physical and social avocational activities they carried out in their daily routine, as reported by them. Exercise capacity (treadmill time) was strongly correlated with a physician's independent assessment of symptomatic status (anginal history). Although participation in some relatively strenuous elective activities was related slightly to exercise capacity, participation in many household duties and social undertakings bore no relationship to exercise capacity or to other measures of the severity of the underlying heart disease. The patients' own perceptions of their cardiac limitation varied for different activities and for some activities it was determined as much by their own concern and outside advice as by cardiac symptoms. Decreased capacity for exertion seems to exert surprisingly little influence on a cardiac patient's daily routine and interventions aimed at altering
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W. A. Neill (1985) conducted an RCT in Chronic coronary disease (n=1,819). Initial invasive strategy vs. Initial conservative strategy was evaluated on SAQ-19 Summary score overall mean difference (MD 1.4, 95% CI 0.2, 2.5). An initial invasive strategy provided a small overall improvement in SAQ-19 Summary scores (mean difference 1.4 points) compared to a conservative strategy, with clinically important benefits limited to patients with more frequent baseline angina.
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