Refractory angina is a growing challenge for palliative medicine: a systematic review of non-invasive interventions

Murphy, Iain; Sivashankar, Akshara; Gadoud, Amy

doi:10.1136/bmjspcare-2020-002202

Cited by 5 publications

(3 citation statements)

References 45 publications

(50 reference statements)

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“…32 Although no large trials on palliative care for ischemic heart disease exist, small studies of noninvasive approaches to anginal pain provide evidence that multidisciplinary angina programs, including rehabilitation therapy and cognitive behavioral therapy, can have a meaningful effect on refractory angina. 33 Studies have shown improvements in angina frequency and severity, treatment satisfaction, quality of life, anxiety and depression, physical function, and hospitalizations. [34][35][36][37][38] The effect on important patient-centered outcomes and pain relief necessitates future study.…”

Section: Palliative Care For Pain Management In Refractory Ischemic H...mentioning

confidence: 99%

Expanding the Paradigm for Cardiovascular Palliative Care

Godfrey,

Kirkpatrick,

Kramer

et al. 2023

Circulation

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Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite medical advances, patients with CVD experience high morbidity and mortality rates, affecting their quality of life and death. Among CVD conditions, palliative care has been studied mostly in patients with heart failure, where palliative care interventions have been associated with improvements in patient-centered outcomes, including quality of life, end-of-life care, and health care use. Although palliative care is now incorporated into the American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines for heart failure, the role of palliative care for non–heart failure CVD remains uncertain. Across all causes of CVD, palliative care can play an important role in all domains of CVD care from initial diagnosis to terminal care. In addition to general cardiovascular palliative care practices applicable to all areas, disease-specific palliative care needs may warrant individualized palliative care models. In this review, we discuss the role of cardiovascular palliative care for ischemic heart disease, valvular disease, arrhythmias, peripheral artery disease, and adult congenital heart disease. Although there are multiple barriers to cardiovascular palliative care, we recommend a framework for studying and developing cardiovascular palliative care models to improve patient-centered goal-concordant care for this underserved patient population.

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Section: Palliative Care For Pain Management In Refractory Ischemic H...mentioning

confidence: 99%

Expanding the Paradigm for Cardiovascular Palliative Care

Godfrey,

Kirkpatrick,

Kramer

et al. 2023

Circulation

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“…Although the prognosis of NORA is favorable with regard to mortality, 7 quality of life in those with severe, disabling angina remains poor often requiring palliative approaches. 8,9 Angiogenesis is mediated by endogenous proangiogenic growth factors, most prominently VEGF (vascular endothelial growth factor). 10 Despite favorable preclinical evidence, clinical investigations of protein, 11,12 plasmid, 13,14 and adenoviral-based 15 growth factor therapy have shown limited success.…”

mentioning

confidence: 99%

“…Although the prognosis of NORA is favorable with regard to mortality, 7 quality of life in those with severe, disabling angina remains poor often requiring palliative approaches. 8 , 9 …”

mentioning

confidence: 99%

Angiogenic Gene Therapy for Refractory Angina: Results of the EXACT Phase 2 Trial

Nakamura,

Henry,

Traverse

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: XC001 is a novel adenoviral-5 vector designed to express multiple isoforms of VEGF (vascular endothelial growth factor) and more safely and potently induce angiogenesis. The EXACT trial (Epicardial Delivery of XC001 Gene Therapy for Refractory Angina Coronary Treatment) assessed the safety and preliminary efficacy of XC001 in patients with no option refractory angina. METHODS: In this single-arm, multicenter, open-label trial, 32 patients with no option refractory angina received a single treatment of XC001 (1×10 11 viral particles) via transepicardial delivery. RESULTS: There were no severe adverse events attributed to the study drug. Twenty expected severe adverse events in 13 patients were related to the surgical procedure. Total exercise duration increased from a mean±SD of 359.9±105.55 seconds at baseline to 448.2±168.45 (3 months), 449.2±175.9 (6 months), and 477.6±174.7 (12 months; +88.3 [95% CI, 37.1–139.5], +84.5 [95% CI, 34.1–134.9], and +115.5 [95% CI, 59.1–171.9]). Total myocardial perfusion deficit on positron emission tomography imaging decreased by 10.2% (95% CI, −3.1% to 23.5%), 14.3% (95% CI, 2.8%–25.7%), and 10.2% (95% CI, −0.8% to −21.2%). Angina frequency decreased from a mean±SD 12.2±12.5 episodes to 5.2±7.2 (3 months), 5.1±7.8 (6 months), and 2.7±4.8 (12 months), with an average decrease of 7.7 (95% CI, 4.1–11.3), 6.6 (95% CI, 3.5–9.7), and 8.8 (4.6–13.0) episodes at 3, 6, and 12 months. Angina class improved in 81% of participants at 6 months. CONCLUSIONS: XC001 administered via transepicardial delivery is safe and generally well tolerated. Exploratory improvements in total exercise duration, ischemic burden, and subjective measures support a biologic effect sustained to 12 months, warranting further investigation. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04125732.

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The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives

Kasdorf

Dust

Hamacher

et al. 2022

Support Care Cancer

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Purpose To compare health care experiences of patients with cancer or non-cancer diseases in their last year of life. Methods A cross-sectional post-bereavement survey was conducted using an adapted German version of the VOICES questionnaire (VOICES-LYOL-Cologne). Differences in the reported experiences were assessed using a two-sided Pearson’s chi-square test and Mann–Whitney U test. Results We collected data from 351 bereaved relatives. More than half of non-cancer patients were not informed that their disease could lead to death (p < 0.001). When this was communicated, in 46.7% of non-cancer and 64.5% of cancer patients, it was reported by the hospital doctor (p = 0.050). In all, 66.9% of non-cancer and 41.6% of cancer patients were not informed about death being imminent (p < 0.001). On average, non-cancer patients had significantly fewer transitions and hospital stays in their last year of life (p = 0.014; p = 0.008, respectively). Non-cancer patients were treated more often by general practitioners, and cancer patients were treated more often by specialists (p = 0.002; p = 0.002, respectively). A substantially lower proportion of non-cancer patients were treated by at least one member of or in the setting of general or specialized palliative care (p < 0.001). Conclusions Non-cancer patients experience disadvantages in communication regarding their care and in access to specialized palliative care in their last year of life compared to cancer patients. Regarding the assessment of palliative care needs and the lack of communication of an incurable disease, non-cancer patients are underserved. An early identification of patients requiring palliative care is a major public health concern and should be addressed irrespective of diagnosis. Trial registration Prospectively registered by the German Clinical Trials Register (DRKS00011925, data of registration: 13.06.2017).

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Refractory angina is a growing challenge for palliative medicine: a systematic review of non-invasive interventions

Cited by 5 publications

References 45 publications

Expanding the Paradigm for Cardiovascular Palliative Care

Expanding the Paradigm for Cardiovascular Palliative Care

Angiogenic Gene Therapy for Refractory Angina: Results of the EXACT Phase 2 Trial

The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives

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