Health-related quality of life in patients with acute coronary syndromes and treated with ticagrelor or clopidogrel

Abstract

Evaluation of: Levin LA, Wallentin L, Bernfort L et al. Health-related quality of life of ticagrelor versus clopidogrel in patients with acute coronary syndromes results from the PLATO trial. Value Health 16(4), 574–580 (2013).

Antiplatelet therapy is considered essential treatment for acute coronary syndromes with or without ST-segment elevation and after stent procedures. The PLATelet inhibition and patient Outcomes (PLATO) trial compared ticagrelor or clopidogrel for the prevention of cardiovascular events. Prespecified substudies included a health-related quality of life (HRQL) study; the EQ-5D, a self-report, standardized, nondisease-specific utility measure with a single index value for health status, was used to assess HRQL. In the primary HRQL analysis, the mean 12-month HRQL score in 15,212 patients was reported to be 0.840 in the ticagrelor group and 0.832 in the clopidogrel group (p = 0.046). Excluding patients who died resulted in no difference in HRQL between patients treated with ticagrelor or clopidogrel (0.864 and 0.863, respectively; p = 0.69). The improved survival and reduction in cardiovascular events with ticagrelor as demonstrated in the main PLATelet inhibition and patient Outcomes trial are apparently obtained with no difference in quality of life.

Keywords::

• acute coronary syndrome
• clopidogrel
• health-related quality of life
• ticagrelor

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Acute coronary syndrome is a major coronary artery disease diagnosis with a significant global medical and economic burden.

• Antiplatelet therapy is considered essential treatment for acute coronary syndromes.

• Antiplatelet therapy with either ticagrelor or clopidogrel has not been linked to health-related quality of life (HRQL) changes.

• HRQL outcomes may have been better assessed with either an ischemic heart disease-specific HRQL questionnaire or the five HRQL dimensions in the EQ-5D rather than the EQ-5D utility index score.

• The change in HRQL with the two treatments was not assessed.

• There is no discussion of the clinical importance of the statistically significant difference in HRQL at 12 months.