RISK-ADJUSTMENT OF 1-YEAR HEALTH STATUS OUTCOMES IN CAD

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The investigators propose to use an existing, well-established clinical database with baseline and 1-year health status data to describe the physical and mental functioning, angina pectoris burden, quality of life in patients 1-year post hospital discharge for acute coronary syndromes. Two distinctly different clinical sites will be utilized. The Mid-American heart Institute is a high volume, referral center that provides advanced cardiac care. The Truman Medical Center is a city hospital largely serving an indigent, urban patient population. No invasive cardiac procedures are performed there. An observation registry of over 3000 patients will be collected over an 18 months (validation cohort of 1500 between months 12 - 18) will be utilized to: 1) describe baseline and 1-year health status of patients admitted with acute coronary syndromes; 2) describe the association between health status and coronary revascularization; 3) determine if health status provides additional predictive value over standard clinical variables in predicting 1-year mortality; and 4) develop multivariable models of 1-year health status. The investigators highlight that their proposed study is responsive to the stated AHCPR priority areas of "supporting improvement in health outcomes" and "strengthening quality measurement". They also state that risk-adjusted models of health outcomes are both markers of health care quality and may be used to facilitate informed patient decisions. Significant modifications of this application have been made in response to the initial review of this study section. The classification of acute coronary syndromes has now been codified with the selection of the Braunwald classification, and the scanning of the electrocardiograms for reading by board-certified cardiologists. Vital status ascertainment has now been clarified. The discussion of the Truman Medical Center and supported provided to the same has been expanded. Low literacy issues have been addressed and preliminary data have been provided. Also, the lack of detail in the analytical plan has been rectified. Finally, the budgetary impact of the two proposed expert consultants has been neutralized. The investigators persuasively argue that their study will likely lead to a truncated set of important predictor variables that will facilitate generalizability of their findings by making implementation of their data collection approach more feasible.