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Response shift in coronary artery disease

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Abstract

Purpose

Patients with coronary artery disease (CAD) experience significant angina symptoms and lifestyle changes. Revascularization procedures can result in better patient-reported outcomes (PROs) than optimal medical therapy (OMT) alone. This study evaluates the impact of response shift (RS) on changes in PROs of patients with CAD across treatment strategies.

Methods

Data were from patients with CAD in the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease (APPROACH) registry who completed the 16-item Canadian version of the Seattle Angina Questionnaire at 2 weeks and 1 year following a coronary angiogram. Multi-group confirmatory factor analysis (MG-CFA) was used to assess measurement invariance across treatment groups at week 2. Longitudinal MG-CFA was used to test for RS according to receipt of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or optimal medical therapy (OMT) alone.

Results

Of the 3116 patients included in the analysis, 443 (14.2%) received CABG, 2049(65.8%) PCI, and the remainder OMT alone. The MG-CFA revealed a partial-strong invariance across the treatment groups at 2 weeks (CFI = 0.98, RMSEA [90% CI] = 0.05 [0.03, 0.06]). Recalibration RS was detected on the Angina Symptoms and Burden subscale and its magnitude in the OMT, PCI, and CABG groups were 0.32, 0.28, and 0.53, respectively. After adjusting for RS effects, the estimated target changes were largest in the CABG group and negligible in the OMT group.

Conclusion

Adjusting for RS is recommended in studies that use SAQ-CAN to assess changes in patients with CAD who have received revascularization versus OMT alone.

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Data availability

The datasets used are available from the Alberta Provincial for Outcome Assessment in Coronary Heart Disease (APPROACH) registry. Though they are not freely available, researchers who fulfill the criteria for access to confidential data can contact the registry for access to the data.

Code availability

Available upon request from the authors.

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Funding

This study was funded by the Canadian Institutes of Health Research Project Grant funding to Dr. Sajobi (Grant#: 400774). OAL was supported by the Libin Cardiovascular Institute of Alberta Doctoral Research Scholarship.

Author information

Authors and Affiliations

  1. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada

    Oluwaseyi A. Lawal, Maria J. Santana, Meng Wang, Matthew T. James & Tolulope T. Sajobi

  2. Faculty of Health Sciences, University of Lethbridge, Lethbridge, Canada

    Oluwagbohunmi A. Awosoga

  3. Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

    Olawale F. Ayilara

  4. Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada

    Michelle M. Graham

  5. Faculty of Nursing, University of Alberta, Edmonton, Canada

    Colleen M. Norris

  6. Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada

    Stephen B. Wilton

  7. Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Canada

    Matthew T. James

Authors
  1. Oluwaseyi A. Lawal
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  2. Oluwagbohunmi A. Awosoga
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  3. Maria J. Santana
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  4. Olawale F. Ayilara
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  5. Meng Wang
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  10. Tolulope T. Sajobi
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Contributions

OAL and TTS conceptualized and designed the study. OAL drafted the first version of the manuscript; OAL and OFA conducted data analysis and interpretation of results. TTS, OAA, MJS, and MTJ supervised OAL’s doctoral dissertation and provided input into the manuscript revision; MW was responsible for data extraction and preprocessing; MTJ, CMN, SBW, and MMG were involved in data collection and facilitated data access. All authors reviewed, critically revised, and approved the manuscript for submission.

Corresponding author

Correspondence to Tolulope T. Sajobi.

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Competing interests

The authors declare that they have no competing interests.

Ethical approval

Ethics approval to use de-identified data from the APPROACH registry was obtained from the University of Calgary Conjoint Health Research Ethics Board (REB22-0804).

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Lawal, O.A., Awosoga, O.A., Santana, M.J. et al. Response shift in coronary artery disease. Qual Life Res 33, 767–776 (2024). https://doi.org/10.1007/s11136-023-03564-1

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