The impact of a short psychological intervention on quality of life and angina control in patients with chronic refractory angina

Abstract

Introduction: Patients with refractory (RA) have chronic disabling chest pain that significantly impacts upon their quality of life. The prevalence of RA is thought to effect in excess of 5% of patients diagnosed with angina. The focus of management in this patient group has traditionally revolved around symptom management through medication, angioplasty and surgery. However, there is a clear lack of a structured pathway of care that addresses their maladaptive psychological response. As a result patients feel that they have no control over their leading to high utilization of medical services, anxiety, depression and poor quality of life. Methods: Bradford Refractory Angina Service (BRAS) has designed a short psychological intervention based upon an education program combined with a course of cognitive behavioral therapy. It is delivered in four two hour sessions over the course of one month by a Clinical Nurse Specialist and a Clinical Psychologist. The impact of this intervention was examined in 33 consecutive patients attending the BRAS between 20011-2012 (25 males, 6 females median age=63). Quality of life scores were assessed by the SF36 questionnaire and frequency/GTN use by the Seattle Angina Questionnaire (SAQ) pre and post intervention. Both questionnaires are well recognized and have been previously validated. Two additional questions were asked of each patient pre and post intervention. How much control you feel you have over your angina? (No control =0, full control 10) and How much does restrict what you do? (Not at all 0, extremely restricted 10). Data were analysed using Wilcoxon paired testing and are presented as medians. Results: Over the 4 week period of the psychological intervention, SF36 Quality of Life scores increased significantly (30 vs 44 P=0.0001) whilst levels of anxiety and depression decreased (8 vs 8 p=0.0049 and 9.5 vs 8 p=0.0152). In response to the question How much control you feel that you have over your angina scores rose significantly (5 vs 7 p=0.0031) and in response to How much does restrict what you do scores fell significantly (8 vs 5 p=0.001). No significant change was noted in either frequency or GTN use. Conclusion: A short psychological intervention combining education with cognitive behavioral therapy is effective in increasing patient's sense of control over their and improves their quality of life. This appears to be achieved independently of any improvement in frequency. Further research is required to see if this effect is maintained in the longer term.