More than 20% of stable outpatients with CAD experience monthly angina
Among stable outpatients with CAD, 21.2% reported experiencing angina at least once monthly, researchers reported.
In the cohort of patients from a primary care network, the following factors were associated with monthly angina: speaking a language other than English or Spanish, Black race, current or former smoking, atrial fibrillation and chronic obstructive pulmonary disease (COPD).
“Prior work has characterized the epidemiology of angina among patients with newly diagnosed obstructive CAD or who have recently experienced myocardial infarction or undergone revascularization,” Daniel M. Blumenthal, MD, MBA, cardiologist at Massachusetts General Hospital and instructor in medicine at Harvard Medical School, and colleagues wrote in JAMA Network Open. “Less work has investigated the prevalence, severity and clinical consequences of angina among patients with medically managed chronic CAD, including patients with both obstructive and nonobstructive CAD and those cared for by primary care physicians, as opposed to cardiologists.”
The cross-sectional survey study included 4,139 adults with established CAD receiving primary care through a large integrated primary care network. Each participant was administered the Seattle Angina Questionnaire-7 through telephone from February to July 2017.
Researchers assessed the prevalence and frequency of angina and analyzed covariates associated with angina.
Of all patients surveyed, 1,612 (mean age, 72 years; 36% women) completed the questionnaire with data available for the study. In the cohort, the mean Seattle Angina Questionnaire-7 score was 93.7. Of all respondents, 21.2% reported experiencing angina at least once monthly, with 12.5% reporting daily or weekly angina and 8.7% reporting monthly angina.
Speaking languages other than English or Spanish (OR = 5.07; 95% CI, 1.39-18.5), 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), AF (OR = 1.52; 95% CI, 1.02-2.26) and COPD (OR = 1.61; 95% CI, 1.18-2.18) were all associated with more frequent angina experience after multivariable adjustments. In addition, male sex (OR = 0.63; 95% CI, 0.47-0.86), peripheral artery disease (OR = 0.63; 95% CI, 0.44-0.9) and novel oral anticoagulant use (OR = 0.19; 95% CI, 0.08-0.48) were all associated with less frequent angina in the cohort.
“Systematic evaluation of angina burden using validated assessment tools and prospective estimation of angina burden may improve angina treatment and may be associated with reduced morbidity,” the researchers wrote.