Abstract P59: Impact of Drug Therapy on Refractory Angina

Abstract

Background: Revascularization is the ultimate therapeutic option for symptomatic angina patients on medical therapy. However, a continuously growing patient population presents with angiographic features not (any more) amenable to revascularization (refractory angina). The impact of medical therapy in refractory angina patients has not been evaluated. We sought to determine the symptom control in ‘spontaneous’ clinical practice and how this is affected by strict implementation of current guidelines for the management of chronic angina. Methods: Patients diagnosed with chronic stable angina who were not candidates for revascularization were included. Drug therapy over the last 4 weeks was recorded and patients were administered the Seattle Angina Questionnaire (SAQ). A 3 week period of drug insertion and/or titration was allowed. All patients were re-evaluated and repeated the SAQ at 6 months. Friedman's test with Bonferroni correction was used to compare difference in angina among the groups. A p value <0.05 was considered statistically significant. Results: A total of 118 patients were included (mean age 72 years; 71% males). Sixty-eight percent of patients were on beta-blockers (BB) (only 40% on maximally tolerated dose), 41% on calcium channel blockers (CCB), 81% on nitrates and 89% on aspirin. According to SAQ, 36% of patients suffered 3 or more angina episodes per week and 19% had heavy limitations in daily activities. At 6 months, 77% of patients were on maximally tolerated BB dose, 44% on CCB, 82% on nitrates and 93% on aspirin. SAQ score results improved significantly, with 20% of patients showing clinically important differences. Twenty-four percent of patients reported 3 or more angina episodes per week and 15% had heavy daily limitations. Conclusions: Refractory angina patients have a poor quality of life and often are not prescribed maximally tolerated drug therapy. Optimization of treatment regimen significantly improves quality of life but is clearly not sufficient for symptom control. Strategies for the treatment of this patient population are needed to be evaluate in clinical trials.