1. The Burden of Angina Summary and Comment by Harlan M. Krumholz, MD, SM Published in Journal Watch Cardiology March 25, 2009Journal Watch Cardiology In a primary care setting, patients with angina alone do not necessarily fare better than those with other manifestations of ischemic heart disease In a primary care setting, patients with angina alone do not necessarily fare better than those with other manifestations of ischemic heart disease. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

2. Covering Buckley B and Murphy AW. Do patients with angina alone have a more benign prognosis than patients with a history of acute myocardial infarction, revascularisation or both? Findings from a community cohort study. Heart 2009 Mar; 95:461. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

3. Background The prognostic importance of angina in the modern era is not well understood. To compare outcomes in patients with angina alone and in those with an acute MI or revascularization treatment, investigators identified 1609 patients with established ischemic heart disease in a random selection of 37 general practices in Ireland during 2000 and 2001. Data were collected from medical records, and physical and mental health status were measured by patient questionnaires at baseline and follow-up. Mean patient age was 65 for men and 68 for women. Overall, 66% of the patients were men. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

4. The Research At an average follow-up of 4.5 years, charts were available for 99% of the cohort. Compared with patients with other manifestations of ischemic heart disease, those with angina alone had a 27% lower risk for all-cause death and a 35% lower risk for ischemic heart disease–related death; these findings were of borderline statistical significance. No significant between-group difference was found in the risk for acute MI. Physical-function scores were significantly lower at baseline and at follow-up in the angina-only group than in the group with other manifestations of ischemic heart disease. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

5. Comment These findings show that in contemporary general practice, angina imposes a substantial burden on patients. We cannot assume that the prognosis for patients with angina only is better than that for patients with other forms of ischemic heart disease. However, whether this prognosis can be modified by treatments aimed at angina remains to be determined. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

6. About Journal Watch Journal Watch helps physicians and allied heath professionals save time and stay informed by providing brief, clearly written, clinically focused perspectives on the medical developments that affect practice. Journal Watch is an independent, trustworthy source, from the publishers of the New England Journal of Medicine. These slides were derived from Journal Watch Cardiology.Journal Watch Cardiology The best way to stay informed with Journal Watch, is through our alerts. To sign up, visit the My Alerts page.My Alerts page CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society