1. The long-term impact of psychotherapy in patients with refractory angina Patel PA2, Ali N1, Thapar S1, Sainsbury PA1 1Department of Cardiology, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ 2Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom
Purpose
Methods
Results
33 patients were present in the initial study. Three underwent subsequent revascularisation and were therefore excluded from our analysis.
Average age was 62 years (SD 12.6), with 25 males and 5 females.
SF36 quality of life scores appeared preserved (45 vs 44, p=0.13). Levels of anxiety (4 vs 8, p=0.26) and depression (4 vs 8, p=0.004) were improved.  No statistically significant change was noted in frequency of angina (5 vs 4, p=0.09) or usage of GTN spray (5 vs 5, p=0.11).
Patients with refractory angina have persistence of symptoms despite optimal pharmacological intervention and revascularisation when feasible1.
It constitutes significant public health burden, affecting in excess of 5% of patients with angina2. Symptoms are typified by a maladaptive psychological response to ischaemic chest pain, commonly allied with high levels of anxiety and depression.
Focus of management appears to lack a structured pathway of care to specifically address this issue. As a consequence, there is high morbidity in such patients with recurrent hospital admissions and compromise in quality of life.
Our hospital has a specialised cardiology service to manage patients with refractory angina (BRAS). Management includes a short psychological intervention, composed of a course of cognitive behavioural therapy (CBT) combined with an education programme. A study into short-term impact has been previously conducted by our group, and demonstrated that intervention improved quality of life and reduced levels of anxiety and depression, without effects on frequency of symptoms. A follow-up study on the same cohort was conducted after a two-year duration, to compare short and long-term outcome measures. 
The intervention was composed of a 1 month course, delivered over 4 sessions with each lasting 2 hours.
These were implemented by a Clinical Nurse Specialist and a Clinical Psychologist in partnership. 
As previously, assessment was performed using well- established and validated questionnaires (SF36 for quality of life, HADS for anxiety/depression, SAQ for angina frequency/GTN spray usage).
Non-parametric data was analysed using Wilcoxon signed- rank testing and presented as medians. Statistical significance was defined by p-values < 0.05.
Conclusions
Our initial study suggested that a short course of psychological intervention was effective in improving patients’ quality of life and mood.
Despite the relatively small sample size, current results indicate that benefits are maintained in the longer term. Frequency of symptoms appears unchanged.
Further research using larger, multi-centre trials appear to be warranted in order that the significant morbidity associated with this chronic disorder can be negated.
1 Kim et al. J Am Coll Cardiol 2002; 39: Banai et al. J Am Coll Cardiol 2007; 49: Furze et al. J Psychosom Res 2005; 59:323-9.
Declaration of interests - None