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DALLAS, TX -– While aggressive procedures such as
angioplasty and coronary bypass procedures improve the health
of patients with heart disease, the benefits are less if
patients don't have the financial means to protect that
"investment" afterwards.

In a study of 800 patients, Duke University Medical Center
researchers have found that heart patients of low
socio-economic status (SES) have a worse quality of life after
these aggressive forms of treatment than better-off and more
educated patients.

"If patients don't understand what healthy living is or
don't have the means to live healthier, they will not do as
well, " said Duke cardiologist Dr. Chen Tung.

The issues facing this group of patients after treatment are
complicated and not easily solved, Tung said. Most need to
drastically change their lifestyles, may need physical
rehabilitation, and need to take heart medications -- aspects
of continuing medical care that can be either out of reach or
not fully understood by most low SES patients.

Tung, who is on the faculty at the Duke Clinical Research
Institute, prepared the results of his study for presentation Tuesday (Nov. 10) at the 71st scientific sessions of the American Heart Association meeting.

The study followed 800 consecutive patients who were
referred to Duke for a cardiac catheterization and who then
went on to receive either an angioplasty or bypass. Of these
patients, 350 were of low SES, which was defined as having less
than nine years of education and an annual income of less than
$10,000. These patients tended to be older than high SES
patients and a higher percentage were women.

The study found that patients from low SES came to the
hospital sicker than high SES patients, and while both groups
experienced small but marked improvements after either
revascularization procedure, the functional status of lower SES
patients remained significantly impaired one year after
treatment.

"We expected all patients to feel bad at the beginning, but
we also expected them to get much better," Tung said. "What is
so striking is after revascularization how much worse the low
SES people felt compared to the higher SES people. We saw at
least a 30 to 40 percent reduction in the functional status and
quality of life despite having the aggressive procedures."

For Tung, the results show that heart procedures aren't
magic bullets that can cure heart disease by themselves,
especially for the poor and less educated.

"Much effort has been placed on providing equal access to
care," Tung said. "While this is indeed important, especially
for low SES patients, more fundamental changes are needed."

Tung believes that an educational component is critical to
the medical care provided low SES patients. To this end, the
Duke team is developing a pilot program for lower SES patients
that stresses the importance of lifestyle and dietary
changes.

Researchers used two different quality-of-life
questionnaires to assess the functional status of patients.
Each test was given to patients at the beginning of the study
and again one year later.

The first, called the Duke Activities Status Index (DASI),
is a questionnaire developed by Duke cardiologists in the
mid-1980s that measures how much a person can do physically.
The second test, called SF-36, is a questionnaire that measures
patients' perceptions of their overall health. Taken together,
the results of these two tools give researchers an insight into
a patient's quality of life, Tung said.