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

Abstract

Objective: This study was designed to assess the impact of a refractory angina programme on the health related quality of life for patients with chronic refractory angina (CRA) one year following enrolment. Design: A one year prospective audit. Setting: Specialist refractory angina clinic at a tertiary cardiac referral centre. Patients: 69 consecutive refractory angina patients referred to a regional refractory angina centre from 1/03/2001 to 1/09/2002. Interventions: Pain treatment algorithm in accordance with the recommendations of the national refractory angina guideline committee. Main outcome measures: Improvements in quality of life indices were assessed using Seattle angina questionnaire (SAQ), and short form-12 (SF-12) with changes in mood determined using the hospital anxiety and depression (HAD) questionnaire. Results: All dimensions of the SF-12 and SAQ were superior at one year with significant improvement seen with the mental component of SF-12 ( p = 0.023), and four of the five SAQ domains, angina stability ( p = 0.028), angina frequency ( p = 0.02), treatment satisfaction ( p = 0.001) and quality of life ( p < 0.001). All the significant changes within the SAQ domains were large enough to be considered clinically relevant. At one year the anxiety and depression domains were significantly improved from baseline ( p = 0.015, 0.018) with clinical anxiety levels falling significantly from 55% to 40%, a relative reduction of 28% ( p = 0.008). Conclusions: 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.