Health related quality of life of patients with refractory angina before and one year after enrolment onto a refractory angina program

Moore, Roger K.; Groves, David G.; Bateson, S.; Barlow, PM; Hammond, C; Leach, Austin; Chester, Michael R.

doi:10.1016/j.ejpain.2004.07.013

Cited by 45 publications

(35 citation statements)

References 27 publications

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“…In accordance with studies of patients with CHD, refractory angina is associated with increased psychological morbidity and a chronically impaired quality of life [10]. It has been suggested that interventions to reduce psychological distress have the potential to improve long-term cardiac prognosis [11].…”

Section: Introductionmentioning

confidence: 75%

“…Previous studies have explored the effect of various therapeutic interventions, including stellate ganglion blocks [4], electrical neuromodulation devices, such as transcutaneous electrical nerve stimulation [5] and spinal cord stimulation [6,7], enhanced external counterpulsation [8], percutaneous myocardial laser revascularisation [9] and a specifically designed management program [10]. However, such treatments have failed to demonstrate a universal impact on the chest pain and dyspnoea associated with refractory angina.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Rehabilitation to Improve Physical Functioning in Refractory Angina: A Pilot Study

et al. 2012

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Objectives: Refractory angina patients suffer debilitating chest pain despite optimal medical therapy and previous cardiovascular intervention. Cardiac rehabilitation is often not prescribed due to a lack of evidence regarding potential efficacy and patient suitability. A randomised controlled study was undertaken to explore the impact of cardiac rehabilitation on cardiovascular risk factors, physical ability, quality of life and psychological morbidity among refractory angina sufferers. Methods: Forty-two refractory angina patients (65.1 ± 7.3 years) were randomly assigned to an 8-week Phase III cardiac rehabilitation program or symptom diary control. Physical assessment, Progressive Shuttle Walk test, Hospital Anxiety and Depression Scale, Health Anxiety Questionnaire, the York Angina Beliefs scale, ENRICHD Social Support Instrument and SF-36 were completed before and after intervention and at 8-week follow-up. Results: Following cardiac rehabilitation, patients demonstrated improved physical ability compared with controls in Progressive Shuttle Walk level attainment (p = 0.005) and total distance covered (p = 0.015). Angina frequency and severity remained unchanged in both groups, with the control demonstrating worsening SF-36 pain scale (63.43 ± 22.28 vs. 55.46 ± 23.98, p = 0.025). Cardiac rehabilitation participants showed improved Health Anxiety Questionnaire reassurance (1.71 ± 1.72 vs. 1.14 ± 1.23, p = 0.026) and York Beliefs anginal threat perception (12.42 ± 4.58 vs. 14.35 ± 4.73, p = 0.05) after cardiac rehabilitation. Physical measures were broadly unaffected. Conclusions: Cardiac rehabilitation can be prescribed to improve physical ability without affecting angina frequency or severity among patients with refractory angina.

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Section: Introductionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Cardiac Rehabilitation to Improve Physical Functioning in Refractory Angina: A Pilot Study

et al. 2012

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“…The prevalence of psychosocial distress in the patient population in the present study was quite high; 21% had at least moderate anxiety, 40% had clinically significant depressive symptoms, 22% exhibited high levels of alexithymia, and 27% had significant somatosensory amplification. Previous estimates of the prevalence of significant depressive symptoms have ranged from 20% to 32% in patients with chronic stable angina 12,38 to 17% to 47% in patients after myocardial infarction. 39 Although the prevalence of the other psychosocial factors in patients with ischemic angina has rarely been documented, in 1 study of 69 patients with refractory angina, 55% of patients demonstrated clinical anxiety, 38 which is not dissimilar from the 44% of patients in the present study with daily or weekly angina who had at least moderate anxiety.…”

Section: Discussionmentioning

confidence: 99%

“…Previous estimates of the prevalence of significant depressive symptoms have ranged from 20% to 32% in patients with chronic stable angina 12,38 to 17% to 47% in patients after myocardial infarction. 39 Although the prevalence of the other psychosocial factors in patients with ischemic angina has rarely been documented, in 1 study of 69 patients with refractory angina, 55% of patients demonstrated clinical anxiety, 38 which is not dissimilar from the 44% of patients in the present study with daily or weekly angina who had at least moderate anxiety. The present study thus supports past research that has demonstrated a high prevalence of psychological distress in patients with symptomatic CAD.…”

Section: Discussionmentioning

confidence: 99%

Psychosocial Modulators of Angina Response to Myocardial Ischemia

et al. 2009

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Background-Although angina is often caused by atherosclerotic obstruction of the coronary arteries, patients with similar amounts of myocardial ischemia may vary widely in their symptoms. We sought to compare clinical and psychosocial characteristics associated with more frequent angina after adjusting for the amount of inducible ischemia. Methods and Results-From 2004 to 2006, 788 consecutive patients undergoing single-photon emission computed tomography stress perfusion imaging at 2 Seattle hospitals were assessed for their frequency of angina over the previous 4 weeks with the Seattle Angina Questionnaire and for a broad range of psychosocial characteristics. Among patients with demonstrable ischemia on single-photon emission computed tomography (summed difference score Ն2; nϭ191), angina frequency was categorized as none (Seattle Angina Questionnaire scoreϭ100; nϭ68), monthly (scoreϭ61 to 99; nϭ66), and weekly or daily (scoreϭ0 to 60; nϭ57). Using multivariable ordinal logistic regression, increasing angina was significantly associated with a history of coronary revascularization (odds ratio 2.24, 95% confidence interval 1.19 to 4.19), anxiety (odds ratio 4.72, 95% confidence interval 1.91 to 11.66), and depression (odds ratio 3.12, 95% confidence interval 1.45 to 6.69) after adjustment for the amount of inducible ischemia. Conclusions-Among patients with a similar burden of inducible ischemia, a history of coronary revascularization and current anxiety and depressive symptoms were associated with more frequent angina. These results support the study of angina treatment strategies that aim to reduce psychosocial distress in conjunction with efforts to lessen myocardial ischemia. (Circulation. 2009;120:126-133.)

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“…Not only are there fewer emergency hospital admissions, once patients have been educated about angina and ischaemic heart disease they become more confident in dealing with painful episodes, but they also experience less frequent and less severe pain, take lower doses of fewer drugs and show a reduction in the rate of myocardial infarction. 27 If symptom load remains excessive following a simple education programme there is a range of low-cost, low-risk interventions (transcutaneous electrical nerve stimulation, upper thoracic sympathetic nerve block and low-dose strong opioids) which can be tried prior to consideration of more invasive techniques such as spinal cord stimulation or further revascularisation.…”

Section: Modern Management Of Stable Anginamentioning

confidence: 99%

Myocardial ischaemia and cardiac pain – a mysterious relationship

Leach

Fisher

2013

British Journal of Pain

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Pain related to cardiac disease has been recognised for centuries. However, the precise mechanisms of angina pectoris remain bafflingly obscure. Conventional cardiological angina management concentrates on methods to improve oxygen delivery to cardiac myocytes as our understanding of cardiac muscle cells' response to hypoxia increases. In common with other chronic visceral pain syndromes, little is understood about how pain signals are generated and propagated by visceral nerves. Improved imaging and other physiological assessments have demonstrated important central nervous system (CNS) responses to myocardial ischaemia, including activation of CNS areas known to be 'key players' in chronic pain syndromes. Patients with stable angina usually have an excellent prognosis, especially if left ventricular function is preserved. Educating patients about their condition, teaching simple techniques known to help chronic pain patients and introducing targeted pain treatments specific to angina can be extremely helpful adjuncts to conventional cardiological treatments and will often bring about significant improvements in quality of life.

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Health related quality of life of patients with refractory angina before and one year after enrolment onto a refractory angina program

Abstract: Implementation of the national refractory angina guidelines in a prospective study of 69 consecutive CRA patients significantly improved health related quality of life status at one year.

Cited by 45 publications

References 27 publications

Cardiac Rehabilitation to Improve Physical Functioning in Refractory Angina: A Pilot Study

Cardiac Rehabilitation to Improve Physical Functioning in Refractory Angina: A Pilot Study

Psychosocial Modulators of Angina Response to Myocardial Ischemia

Myocardial ischaemia and cardiac pain – a mysterious relationship

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