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
Observational Study
. 2016;2(3):208-214.
doi: 10.1093/ehjqcco/qcw016. Epub 2016 Mar 25.

Effect of angina under-recognition on treatment in outpatients with stable ischaemic heart disease

Mohammed Qintar  1 , John A Spertus  1 , Kensey L Gosch  2 , John Beltrame  3 , Faraz Kureshi  1 , Ali Shafiq  1 , Tracie Breeding  2 , Karen P Alexander  4 , Suzanne V Arnold  1
Affiliations
Observational Study

Effect of angina under-recognition on treatment in outpatients with stable ischaemic heart disease

Mohammed Qintar et al. Eur Heart J Qual Care Clin Outcomes. 2016.

Abstract

Aims: Almost a third of outpatients with chronic coronary artery disease (CAD) report having angina in the prior month, which is frequently under-recognized by their cardiologists. Whether under-recognition is associated with less treatment escalation to control angina, and potential underuse of treatment, is unknown.

Methods and results: Patients with CAD from 25 US cardiology outpatient practices completed the Seattle Angina Questionnaire (SAQ) prior to their clinic visit, and angina was categorized as daily, weekly, monthly and no angina. Cardiologists (n=155) independently quantified patients' angina, blinded to patients' SAQ scores. Under-recognition was defined as the physician reporting a lower category of angina frequency than the patient. Among 1257 patients with CAD, 411 reported angina in the past month, of whom 178 (43.3%) patients were under-recognized. Treatment escalation-defined as intensification (up-titration or addition) of antianginal medications, referral for diagnostic testing or revascularization, or hospital admission-occurred in 106 (25.8%) patients with angina. Patients with under-recognized angina were less likely to get treatment escalation than patients whose angina was appropriately recognized (8.4% vs 39.1%, P<0.001). In a hierarchical multivariable logistic regression model adjusting for demographic and clinical characteristics, as well as the burden of angina, under-recognition remained strongly associated with a lack of treatment escalation (adjusted OR 0.10, 95% CI 0.04-0.21, P<0.001).

Conclusions: Under-recognition of angina in cardiology outpatient practices is associated with less aggressive treatment escalation and may lead to poorer angina control. Standardizing clinical recognition of angina using validated tools could reduce under-recognition of angina, facilitate treatment, and potentially improve outcomes.

Keywords: angina; antianginal medications; coronary artery disease; quality of care.

PubMed Disclaimer

Conflict of interest statement

Disclosure of potential conflicts of interest. The remaining authors have no relevant relationships to disclose.

Figures

Figure 1
Figure 1
Treatment escalation based on angina frequency and recognition of angina by the physician. P-value is <0.001 for all comparisons of under- vs. appropriately recognized angina.
Figure 2
Figure 2
Variability in treatment escalation among different study sites.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB, American Heart Association Statistics C, Stroke Statistics S. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation 2015;131:e29–e322. - PubMed
    1. Brorsson B, Bernstein SJ, Brook RH, Werko L. Quality of life of patients with chronic stable angina before and four years after coronary revascularisation compared with a normal population. Heart 2002;87:140–145. - PMC - PubMed
    1. Weintraub WS, Spertus JA, Kolm P, Maron DJ, Zhang Z, Jurkovitz C, Zhang W, Hartigan PM, Lewis C, Veledar E, Bowen J, Dunbar SB, Deaton C, Kaufman S, O'Rourke RA, Goeree R, Barnett PG, Teo KK, Boden WE, Group CTR, Mancini GB. Effect of PCI on quality of life in patients with stable coronary disease. N Engl J Med 2008;359:677–687. - PubMed
    1. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB 3rd, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR Jr, Smith SC Jr, Spertus JA, Williams SV, American College of Cardiology F, American Heart Association Task Force on Practice G, American College of P, American Association for Thoracic S, Preventive Cardiovascular Nurses A, Society for Cardiovascular A, Interventions, Society of Thoracic S. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012;60:e44–e164. - PubMed
    1. Kernis SJ, Harjai KJ, Stone GW, Grines LL, Boura JA, O'Neill WW, Grines CL. Does beta-blocker therapy improve clinical outcomes of acute myocardial infarction after successful primary angioplasty? J Am Coll Cardiol 2004;43:1773–1779. - PubMed

Publication types

MeSH terms

Substances