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
. 2021 Jun 1;4(6):e2112800.
doi: 10.1001/jamanetworkopen.2021.12800.

Prevalence of Angina Among Primary Care Patients With Coronary Artery Disease

Daniel M Blumenthal  1   2   3 , Sidney E Howard  4 , Jennifer Searl Como  5 , Sandra M O'Keefe  6 , Steven J Atlas  2   6 , Daniel M Horn  2   5   6 , Neil W Wagle  2   7   8 , Jason H Wasfy  1   2   5 , Robert W Yeh  2   9   10 , Joshua P Metlay  2   4   6
Affiliations

Prevalence of Angina Among Primary Care Patients With Coronary Artery Disease

Daniel M Blumenthal et al. JAMA Netw Open. .

Abstract

Importance: Angina pectoris is associated with morbidity and mortality. Angina prevalence and frequency among contemporary US populations with coronary artery disease (CAD) remain incompletely defined.

Objective: To ascertain the angina prevalence and frequency among stable outpatients with CAD.

Design, setting, and participants: This cross-sectional survey study involved telephone-based administration of the Seattle Angina Questionnaire-7 (SAQ-7) between February 1, 2017, and July 31, 2017, to a nonconvenience sample of adults with established CAD who receive primary care through a large US integrated primary care network. Data analysis was performed from August 2017 to August 2019.

Exposure: SAQ-7 administration.

Main outcomes and measures: Angina prevalence and frequency were assessed using SAQ-7 question 2. Covariates associated with angina were assessed in univariable and multivariable regression.

Results: Of 4139 eligible patients, 1612 responded to the survey (response rate, 38.9%). The mean (SD) age of the respondents was 71.8 (11.0) years, 577 (35.8%) were women, 1447 (89.8%) spoke English, 147 (9.1%) spoke Spanish, 1336 (82.8%) were White, 76 (4.7%) were Black, 92 (5.7%) were Hispanic, 974 (60.4%) had Medicare, and 83 (5.2%) had Medicaid. Among respondents, 342 (21.2%) reported experiencing angina at least once monthly; among those, 201 (12.5%) reported daily or weekly angina, and 141 respondents (8.7%) reported monthly angina. The mean (SD) SAQ-7 score was 93.7 (13.7). After multivariable adjustment, speaking a language other than Spanish or English (odds ratio [OR], 5.07; 95% CI, 1.39-18.50), Black race (OR, 2.01; 95% CI, 1.08-3.75), current smoking (OR, 1.88; 95% CI, 1.27-2.78), former smoking (OR, 1.69; 95% CI, 1.13-2.51), atrial fibrillation (OR, 1.52; 95% CI, 1.02-2.26), and chronic obstructive pulmonary disease (OR, 1.61; 95% CI, 1.18-2.18) were associated with more frequent angina. Male sex (OR, 0.63; 95% CI, 0.47-0.86), peripheral artery disease (OR, 0.63; 95% CI, 0.44-0.90), and novel oral anticoagulant use (OR, 0.19; 95% CI, 0.08-0.48) were associated with less frequent angina.

Conclusions and relevance: Among stable outpatients with CAD receiving primary care through an integrated primary care network, 21.2% of surveyed patients reported experiencing angina at least once monthly. Several objective demographic and clinical characteristics were associated with angina frequency. Proactive assessment of angina symptoms using validated assessment tools and estimation of patients at higher risk of suboptimally controlled angina may be associated with reduced morbidity.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Blumenthal reported serving as the Chief Executive Officer of Coeur Value, LLC, which is dedicated to improving the quality and value of cardiovascular disease care in the US, and previously being employed by Devoted Health, Inc. Dr Atlas reported receiving grants from Bristol Myers Squibb/Pfizer Alliance and Bristol Myers Squibb, and personal fees from Bristol Myers Squibb and Fitbit outside the submitted work. Dr Wasfy reported receiving grants from American Heart Association and National Institutes of Health/Harvard Catalyst during the conduct of the study, and personal fees from Pfizer outside the submitted work. Dr Yeh reported receiving personal fees from Abbott Vascular, Boston Scientific, and Medtronic; and grants from AstraZeneca, BD Bard, Cook Medical, and Philips outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Patient Enrollment Flowchart
CAD indicates coronary artery disease; MGH, Massachusetts General Hospital; PBRN, Primary Care Practice Based Research Network; PHC, population health coordinator; SAQ-7, Seattle Angina Questionnaire–7.
Figure 2.
Figure 2.. Frequency of Angina Among Seattle Angina Questionnaire–7 Respondents
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Chan PS, Jones PG, Arnold SA, Spertus JA. Development and validation of a short version of the Seattle Angina Questionnaire. Circ Cardiovasc Qual Outcomes. 2014;7(5):640-647. doi:10.1161/CIRCOUTCOMES.114.000967 - DOI - PMC - PubMed
    1. Hemingway H, McCallum A, Shipley M, Manderbacka K, Martikainen P, Keskimäki I. Incidence and prognostic implications of stable angina pectoris among women and men. JAMA. 2006;295(12):1404-1411. doi:10.1001/jama.295.12.1404 - DOI - PubMed
    1. Javitz HS, Ward MM, Watson JB, Jaana M. Cost of illness of chronic angina. Am J Manag Care. 2004;10(11)(suppl):S358-S369. - PubMed
    1. Will JC, Yuan K, Ford E. National trends in the prevalence and medical history of angina: 1988 to 2012. Circ Cardiovasc Qual Outcomes. 2014;7(3):407-413. doi:10.1161/CIRCOUTCOMES.113.000779 - DOI - PMC - PubMed
    1. Alexander KP, Cowper PA, Kempf JA, Lytle BL, Peterson ED. Profile of chronic and recurrent angina pectoris in a referral population. Am J Cardiol. 2008;102(10):1301-1306. doi:10.1016/j.amjcard.2008.07.006 - DOI - PubMed

Publication types