Percutaneous revascularization for ischemic left ventricular dysfunction: Cost-effectiveness analysis of the REVIVED-BCIS2 trial

BACKGROUND: Percutaneous coronary intervention (PCI) is frequently undertaken in patients with ischemic left ventricular systolic dysfunction. The REVIVED (Revascularization for Ischemic Ventricular Dysfunction)-BCIS2 (British Cardiovascular Society-2) trial concluded that PCI did not reduce the incidence of all-cause death or heart failure hospitalization; however, patients assigned to PCI reported better initial health-related quality of life than those assigned to optimal medical therapy (OMT) alone. The aim of this study was to assess the cost-effectiveness of PCI+OMT compared with OMT alone. METHODS: REVIVED-BCIS2 was a prospective, multicenter UK trial, which randomized patients with severe ischemic left ventricular systolic dysfunction to either PCI+OMT or OMT alone. Health care resource use (including planned and unplanned revascularizations, medication, device implantation, and heart failure hospitalizations) and health outcomes data (EuroQol 5-dimension 5-level questionnaire) on each patient were collected at baseline and up to 8 years post-randomization. Resource use was costed using publicly available national unit costs. Within the trial, mean total costs and quality-adjusted life-years (QALYs) were estimated from the perspective of the UK health system. Cost-effectiveness was evaluated using estimated mean costs and QALYs in both groups. Regression analysis was used to adjust for clinically relevant predictors. RESULTS: Between 2013 and 2020, 700 patients were recruited (mean age: PCI+OMT=70 years, OMT=68 years; male (%): PCI+OMT=87, OMT=88); median follow-up was 3.4 years. Over all follow-ups, patients undergoing PCI yielded similar health benefits at higher costs compared with OMT alone (PCI+OMT: 4.14 QALYs, £22 352; OMT alone: 4.16 QALYs, £15 569; difference: −0.015, £6782). For both groups, most health resource consumption occurred in the first 2 years post-randomization. Probabilistic results showed that the probability of PCI being cost-effective was 0. CONCLUSIONS: A minimal difference in total QALYs was identified between arms, and PCI+OMT was not cost-effective compared with OMT, given its additional cost. A strategy of routine PCI to treat ischemic left ventricular systolic dysfunction does not seem to be a justifiable use of health care resources in the United Kingdom

Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: Prespecified analyses from the REVIVED-BCIS2 trial

BACKGROUND: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82–1.30]; P =0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920048

The Imperative for Expressive Arts Education in Primary Schools in Scotland

The arts play a pivotal role in shaping identities, fostering connections, and enriching lives. Within education, the Expressive Arts serve as a powerful means for children and young people as they seek to express themselves, engage in self-discovery, and support them in nurturing a deep connection with the world around them. This blog presents the current state of Expressive Arts education in Primary schools in Scotland

The Imperative for Expressive Arts Education in Primary Schools in Scotland

The arts play a pivotal role in shaping identities, fostering connections, and enriching lives. Within education, the Expressive Arts serve as a powerful means for children and young people as they seek to express themselves, engage in self-discovery, and support them in nurturing a deep connection with the world around them. This blog presents the current state of Expressive Arts education in Primary schools in Scotland

The state of the arts:the challenge for the arts in Primary education in Scotland - a symposium

The Expressive Arts have been long established in curricula guidelines in Scotland, with learners able to enjoy the breadth and depth of a range of Expressive Arts learning activities. At a time when education systems are looking to refresh learning and teaching post-Covid, there is a need to take stock and consider the role of the arts in the education of children and young people, but also what are the challenges in fulfilling this role? This symposium explores the current ‘state of the arts’ in the Primary school in Scotland. It will present findings from three interlinked research projects (Art, Dance and Music) which each explored two specific aims: primary teachers’ knowledge and confidence relating to teaching the arts in their classrooms; and, the content of arts education in primary-focused Initial Teacher Education (ITE) programmes. Each paper will present key findings based on these aims, providing insight into the current ‘state’ and the challenges for teachers in ensuring that children have access to quality expressive arts learning experiences through Curriculum for Excellence (CfE). It is these challenges and, most importantly, the ways to overcome and meaningfully address them as an education system, that we are keen to explore through discussion with delegates.Paper 1: ArtAnna RobbResearch on art and design education in primary schools in the United Kingdom is an active and growing field. This paper presents the view from Scotland and draws upon a 2022 study which explored teachers’ experiences and associated knowledge and beliefs about art and design education in primary classrooms. Data were gathered in the form of an online survey, with 110 primary teachers responding. Key findings indicated that most respondents believed that teaching art in primary schools was the responsibility of the classroom teacher. They also indicated that while confidence levels to teach single art lessons were relatively high, these levels began to dip once the focus was on planning and delivering a programme of work in art and design. This paper will discuss these findings in more depth, presenting a current picture of art and design teaching in primary schools.Paper 2: DanceEilidh SlatteryDance education is a valuable yet often neglected area of the curriculum. Drawing on the analysis of data from over 200 respondents, this paper will discuss the relationship between primary teachers’ prior experience and/or qualifications in dance, their beliefs regarding the importance of dance within education, and teacher confidence to deliver dance as part of the curriculum. This paper will also investigate some key issues identified in the data, including the overall inequity and disparity of experience in terms of dance education throughout a teacher’s own learning experiences in school, and in their developmental journey to becoming a teacher.Paper 3: MusicLio Moscardini and Angela JaapMusic is a much-valued component of arts education in Scotland, with a presence in various curricula since at least the 1900s. Yet while Music continues to be valued by practitioners there is an ongoing and significant concern relating to the regularity and content of music teaching in the primary classroom. This paper will share the findings of data gathered from over 400 Primary teachers and discuss some of the key issues which emerged including primary teachers’ knowledge and beliefs about music education; primary teachers’ confidence in and preparedness for teaching music; primary teachers’ accounts of practice relating to music education in the classroom; accessibility to music education for all children. ReferencesMoscardini, L., Jaap, A., Rae, A., and Wilson, A. (2021) Music Education in Primary Schools in Scotland. Research Report submitted to the Royal Conservatoire of Scotland.Slattery, E. and Rae, A. (2022) Dance Education in Primary Schools in Scotland. Research Report submitted to the Royal Conservatoire of Scotland.ThemesCreative Approaches - (Arts Based & Creativities & Nature, Outdoor Learning and Play)Second ThemeTeacher Education and Developmen

The state of the arts:the challenge for the arts in Primary education in Scotland - a symposium

The Expressive Arts have been long established in curricula guidelines in Scotland, with learners able to enjoy the breadth and depth of a range of Expressive Arts learning activities. At a time when education systems are looking to refresh learning and teaching post-Covid, there is a need to take stock and consider the role of the arts in the education of children and young people, but also what are the challenges in fulfilling this role? This symposium explores the current ‘state of the arts’ in the Primary school in Scotland. It will present findings from three interlinked research projects (Art, Dance and Music) which each explored two specific aims: primary teachers’ knowledge and confidence relating to teaching the arts in their classrooms; and, the content of arts education in primary-focused Initial Teacher Education (ITE) programmes. Each paper will present key findings based on these aims, providing insight into the current ‘state’ and the challenges for teachers in ensuring that children have access to quality expressive arts learning experiences through Curriculum for Excellence (CfE). It is these challenges and, most importantly, the ways to overcome and meaningfully address them as an education system, that we are keen to explore through discussion with delegates.Paper 1: ArtAnna RobbResearch on art and design education in primary schools in the United Kingdom is an active and growing field. This paper presents the view from Scotland and draws upon a 2022 study which explored teachers’ experiences and associated knowledge and beliefs about art and design education in primary classrooms. Data were gathered in the form of an online survey, with 110 primary teachers responding. Key findings indicated that most respondents believed that teaching art in primary schools was the responsibility of the classroom teacher. They also indicated that while confidence levels to teach single art lessons were relatively high, these levels began to dip once the focus was on planning and delivering a programme of work in art and design. This paper will discuss these findings in more depth, presenting a current picture of art and design teaching in primary schools.Paper 2: DanceEilidh SlatteryDance education is a valuable yet often neglected area of the curriculum. Drawing on the analysis of data from over 200 respondents, this paper will discuss the relationship between primary teachers’ prior experience and/or qualifications in dance, their beliefs regarding the importance of dance within education, and teacher confidence to deliver dance as part of the curriculum. This paper will also investigate some key issues identified in the data, including the overall inequity and disparity of experience in terms of dance education throughout a teacher’s own learning experiences in school, and in their developmental journey to becoming a teacher.Paper 3: MusicLio Moscardini and Angela JaapMusic is a much-valued component of arts education in Scotland, with a presence in various curricula since at least the 1900s. Yet while Music continues to be valued by practitioners there is an ongoing and significant concern relating to the regularity and content of music teaching in the primary classroom. This paper will share the findings of data gathered from over 400 Primary teachers and discuss some of the key issues which emerged including primary teachers’ knowledge and beliefs about music education; primary teachers’ confidence in and preparedness for teaching music; primary teachers’ accounts of practice relating to music education in the classroom; accessibility to music education for all children. ReferencesMoscardini, L., Jaap, A., Rae, A., and Wilson, A. (2021) Music Education in Primary Schools in Scotland. Research Report submitted to the Royal Conservatoire of Scotland.Slattery, E. and Rae, A. (2022) Dance Education in Primary Schools in Scotland. Research Report submitted to the Royal Conservatoire of Scotland.ThemesCreative Approaches - (Arts Based & Creativities & Nature, Outdoor Learning and Play)Second ThemeTeacher Education and Developmen