Chronic Stable Angina: What Can We Do Better?

The impact of chronic stable angina on QOL is often underappreciated and disease management remains suboptimal.

The impact of chronic stable angina on quality of life (QOL) is often underappreciated and disease management remains suboptimal, according to a review published in the International Journal of Cardiology.1

“Neither physicians nor their patients need to accept that a certain level of angina symptoms is unavoidable,” write A. John Camm, MD, from the cardiac research center at St. George’s University of London, UK, and colleagues.

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Chronic stable angina is caused by coronary artery disease (CAD), and defined as a mismatch between the demand for oxygen to the heart and the coronary arteries’ ability to supply it. Triggers include exercise, emotional stress, eating, and cold weather. Management may consist of medications, lifestyle changes, and revascularization procedures.

Despite the availability of guidelines and treatment options, studies consistently show that up to 30% of patients continue to suffer from angina, even after invasive revascularization procedures to restore blood flow, the authors write.

“I think we have plenty of drugs available, new techniques, lifestyle changes, and guidelines. The problem is the implementation of the guidelines and the adherence to drug treatment,” coauthor Athanasios J. Manolis, MD, director of cardiology at Asklepeion Hospital in Athens, Greece, told Clinical Pain Advisor.

Quality of Life is Important

Management goals for stable angina include relieving symptoms, reducing risk, and improving QOL.

According to the authors, the effect of angina on patient QOL is often significantly underestimated by clinicians, as demonstrated in the Coronary Artery Disease in General Practice (CADENCE) study of over 2000 patients in 207 Australian primary care practices. Healthcare providers reported that stable angina was adequately controlled in 80% of patients overall, but that 61% were minimally impaired by the condition. However, 53% of patients reported that angina impaired their enjoyment of life.

“I think it is probably true [that] the impact of angina is under-reported,” says Scott D. Jerome, DO, assistant professor of medicine at the University of Maryland School of Medicine, and director of ambulatory services and outreach cardiology at University of Maryland Medical Center in Baltimore.