Frequent Angina Prevalent in Patients with Coronary Artery Disease

Daniel Blumenthal, MD

While angina pectoris is typically associated with morbidity and mortality, there is a lack of definition on the prevalence of angina in patients with chronic coronary artery disease (CAD).

A team of investigators, led by Daniel M. Blumenthal, MD, Cardiology Division, Department of Medicine, Massachusetts General Hospital, found 21.2% of patients surveyed with CAD reported undergoing angina at least once monthly.

The team administered the Seattle Angina Questionnaire-7 (SAQ-7) to a sample of outpatients with diagnosed CAD who receive care in a large primary care network.

Study

Investigators conducted a cross-sectional survey of primary care clinic-based sample of adults with CAD.

The SAQ-7 was administered by telephone between February– July 2017.

Patients were sampled from 15 primary care clinics and community health centers part of the Massachusetts General Hospital (MGH) Primary Care Practice Based Research Network (PBRN). The PBRN contains health record data on 161,000 MGH primary care patients.

Of these patients, those with CAD aged ≥30 years were eligible for study participation, including those with asymptomatic and non-obstructive CAD.

Baseline demographic and clinical characteristics were accessed in 12 months prior to survey administration from the PBRN.

In addition, the team stratified responders into daily or weekly angina, monthly angina, or no angina and evaluated if baseline CAD burden was association with angina frequency assessed by the SAQ-7.

Further, they estimated multivariable multinomial logistic regression that included 4 covariate categories, including demographic covariates, clinical covariates other than medications, medications, and baseline CAD burden.

Results

Investigators identified 9356 patients with CAD aged ≥30 years who were alive in June 2016.

After screening, 4139 of 4789 (86.4%) were deemed eligible for survey completion and contacted to complete a survey.

Data show the mean age of survey respondents was 71.8 years, with 577 (35.8%) 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.

The team found that the mean SAQ-7 score was 93.7. Of the total respondents, 1270 (78.8%) reported no angina and 342 (21.2%) reported experiencing angina at least once monthly.

Further, 201 (12.5%) respondents reported daily, or weekly angina and 141 (8.7%) respondents reported monthly angina.

Investigators observed covariates associated with more frequent angina after multivariable regression,

These included 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).

On the other hand, 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.

Conclusion

The team noted that the findings suggested angina is prevalent in US outpatients with CAD, where proactive angina assessment may later have association with improved treatment and outcomes.

“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,” investigators wrote.

The study, “Prevalence of Angina Among Primary Care Patients with Coronary Artery Disease,” was published online in JAMA Network Open.