Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2017 Jan;40(1):6-10.
doi: 10.1002/clc.22628. Epub 2016 Nov 7.

The prevalence and management of angina among patients with chronic coronary artery disease across US outpatient cardiology practices: insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study

Faraz Kureshi  1   2 , Ali Shafiq  1   2 , Suzanne V Arnold  1   2 , Kensey Gosch  1 , Tracie Breeding  1 , Ashwath S Kumar  2 , Philip G Jones  1 , John A Spertus  1   2
Affiliations
Multicenter Study

The prevalence and management of angina among patients with chronic coronary artery disease across US outpatient cardiology practices: insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study

Faraz Kureshi et al. Clin Cardiol. 2017 Jan.

Abstract

Although eliminating angina is a primary goal in treating patients with chronic coronary artery disease (CAD), few contemporary data quantify prevalence and severity of angina across US cardiology practices. The authors hypothesized that angina among outpatients with CAD managed by US cardiologists is low and its prevalence varies by site. Among 25 US outpatient cardiology clinics enrolled in the American College of Cardiology Practice Innovation and Clinical Excellence (PINNACLE) registry, we prospectively recruited a consecutive sample of patients with chronic CAD over a 1- to 2-week period at each site between April 2013 and July 2015, irrespective of the reason for their appointment. Eligible patients had documented history of CAD (prior acute coronary syndrome, prior coronary revascularization procedure, or diagnosis of stable angina) and ≥1 prior office visit at the practice site. Angina was assessed directly from patients using the Seattle Angina Questionnaire Angina Frequency score. Among 1257 patients from 25 sites, 7.6% (n = 96) reported daily/weekly, 25.1% (n = 315) monthly, and 67.3% (n = 846) no angina. The proportion of patients with daily/weekly angina at each site ranged from 2.0% to 24.0%, but just over half (56.3%) were on ≥2 antianginal medications, with wide variability across sites (0%-100%). One-third of outpatients with chronic CAD managed by cardiologists report having angina in the prior month, and 7.6% have frequent symptoms. Among those with frequent angina, just over half were on ≥2 antianginal medications, with wide variability across sites. These findings suggest an opportunity to improve symptom control.

Keywords: Ischemic heart disease; angina; chronic.

PubMed Disclaimer

Conflict of interest statement

Faraz Kureshi and Ali Shafiq received support from the National Heart, Lung, and Blood Institute of the National Institutes of Health under award no. T32HL110837. Dr. Spertus received funding from Gilead Sciences to conduct this study, although the sponsor had no input on the design, analysis, interpretation, or decision to publish these results. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Figures

Figure 1
Figure 1
Frequency of patient reported angina as measured by the SAQ AF domain score among stable CAD patients (n = 1257). Abbreviations: CAD, coronary artery disease; SAQ AF, Seattle Angina Questionnaire Angina Frequency.
Figure 2
Figure 2
Intensity of antianginal pharmacologic management for patients with frequent (daily/weekly) angina (n = 96).
Figure 3
Figure 3
Proportion of patients with CAD and frequent (daily/weekly) angina (n = 96) and the proportion of frequent angina patients treated with optimal medical antianginal therapy (≥2 medications) by site. Abbreviations: CAD, coronary artery disease.
See this image and copyright information in PMC

References

    1. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–e322. - PubMed
    1. Abrams J. Chronic stable angina [published correction appears in N Engl J Med. 2005;353:2728]. N Engl J Med. 2005;352:2524–2533. - PubMed
    1. Hemingway H, McCallum A, Shipley M, et al. Incidence and prognostic implications of stable angina pectoris among women and men [published correction appears in JAMA. 2006;295:2482]. JAMA. 2006;295:1404–1411. - PubMed
    1. Fox KA, Eagle KA, Gore JM, et al. The Global Registry of Acute Coronary Events, 1999 to 2009—GRACE. Heart. 2010;96:1095–1101. - PubMed
    1. Peterson ED, Roe MT, Rumsfeld JS, et al. A call to ACTION (Acute Coronary Treatment and Intervention Outcomes Network): A national effort to promote timely clinical feedback and support continuous quality improvement for acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2009;2:491–499. - PubMed

Publication types

LinkOut - more resources