In a recent study published in European Heart Journal Open, researchers evaluate the impacts of population-level cardiovascular disease (CVD) screening on health-related quality of life (HRQoL). The effects of receiving an invitation for screening, positive test results, prophylactic treatment initiation, enrollment in surveillance schemes at surgical departments, and preventive surgical repair on HRQoL were assessed.
Study: The impact of population screening for cardiovascular disease on quality of life. Image Credit: Koldunov / Shutterstock.com
Two large cardiovascular screening trials including the VIVA and DANCAVAS trials, have recently been published and offer potentially pivotal evidence for improving the prevention of CVD. The risk-benefit ratio of CVD screening must be determined and any potential harm must be identified and measured.
Sources of harm include physical discomfort from screening, as well as subsequent therapy and psychological discomfort from risk awareness and enrollment in surveillance programs. Both sources can be measured using generic HRQoL instruments such as the EuroQoL.
Unbiased estimates of the potential harm of CVD screening are particularly important from an ethical and policy-making standpoint, as decisions by health authorities are increasingly based on quality-adjusted life years (QALY).
About the study
A difference-in-difference (DID) study design that included the event date, event status, smoking status, and HRQoL data from two large-scale randomized controlled trials (RCTs) was used for the current study. Taken together, this study included 33,769 males residing in South Denmark between 60 to 74 years of age who were randomized to CVD screening or no screening between 2014 and 2019. Socioeconomic and demographic data were obtained from the national registry.
Repeated HRQoL measurements were obtained for up to three years using EuroQol scales such as the EuroQol 5-dimension profile index (EQ-5D-5L) to assess anxiety/depression using the preference weights for Denmark and the EuroQol visual analogue scale (EQVAS) to evaluate overall health. The mean values for changes in scores in the events following CVD screening were calculated.
The impact of five CVD screening-generated events was evaluated. These included being invited for CVD screening; receiving test results, the initiation of preventive treatment, enrollment in surveillance schemes to assess surgical repair requirements, and preventive surgical repair. The comparators were assessed based on the actual event dates in the event group and were synthesized for the no-event groups based on the means for the event groups.
Propensity score matching (PSM) balanced baseline differences in covariates and compared the matched and unmatched results. Individuals were sent invitation letters, including the EuroWoL questionnaire, to participate in the study. Willingness to participate was inferred from the individuals’ responses to the questionnaire.
The attendees were reportedly slightly better off HRQoL-wise than non-attendees on all EuroQol scales. In regard to the receipt of test results, initiating prophylactic therapy, being recruited in surveillance schemes, and surgical restoration, CVD screening did not significantly impact HRQoL. However, a minor effect of being recruited for CVD surveillance schemes on emotional discomfort was observed in the unmatched data but not in the matched data.
Receiving invites to attend CVD screening significantly lowered emotional distress by 2% and increased HRQoL by 3% in the matched and unmatched analyses. A tendency was observed for improved global health over time among individuals testing negative in the unmatched data. This corresponded to a 1% change from baseline and significantly impacted global health in the matched data with a 2% increase as potential reassurance on health.
Initiation of preventive treatment such as antithrombotic medications, statins, and antihypertensives negatively impacted global health by 3%. This impact was only observed in the physical health domain, rather than the general QoL or emotional domains, thus indicating that the effect could be due to medication side effects.
Enrolling in surveillance schemes increased emotional discomfort by 7% in the unmatched analysis and reduced to 5% in the matched data. In regard to surgical-type repair, both the no-event and event groups showed identical patterns over time for all the scales. Preventive surgical repair did not affect HRQoL, which would otherwise cause serious harm.
Individuals who attended the CVD screening had better HRQoL than non-attendees. The frequently reported negative effects of CVD screening on health-related QoL could not be confirmed.
Among CVD screening-generated events, only two consequences of reassurance effects after negative screening tests and slightly negative effects on emotional distress after being recruited in surveillance programs were observed; however, the events did not impact the overall HRQoL.
- Søgaard, R., Diederichsen, A., & LIndholt, J. (2023). The impact of population screening for cardiovascular disease on quality of life. European Heart Journal Open. doi:10.1093/ehjopen/oead055