Evaluation of health-related quality of life changes in an Australian rapid access chest pain clinic

Objective: To evaluate the impact of absolute cardiovascular risk counselling on quality-of-life indices within a chest pain clinic.

Data sources and study setting: Primary data was collected at the Royal Hobart Hospital, Australia, between 2014 and 2020.

Study design: Patients attending an Australian chest pain clinic were randomised into a prospective, open-label, blinded-endpoint study over a minimum 12-months follow-up.

Data collection / extraction methods: The SF-36 questionnaire was completed at baseline/follow-up and SF-6D multi-attribute utility instrument's health state utilities (HSU) were generated using SF-36 responses and the SF-6D's Australian tariff. SF-6D minimal important difference was 0.04 points. Absolute cardiovascular risk was also stratified into high/intermediate/low-risk categories for exploratory analysis of summary HSUs and dimensional scores. ANZCTR registration number 12617000615381 (registered 28/4/17).

Principal findings: Of n = 189 patients enrolled, HSUs were generated for 96% at baseline (intervention n = 93, usual care n = 88) and 61% at follow-up. There were no statistical differences in age, sex, absolute cardiovascular risk or mean HSU between groups at baseline. Summary HSUs improved more for the intervention group and the median between-group difference exceeded the minimal important difference threshold (intervention 0.16 utility points, control 0.10 utility points). For Intervention patients with high absolute risk (≥ 15%), HSU did not significantly change.

Conclusions: Absolute cardiovascular risk counselling in a chest pain clinic yielded clinically meaningful improvement in health-related quality of life.