Fatality, morbidity and quality of life in patients with refractory angina pectoris

Background: Refractory angina pectoris has been defined as coronary artery disease and severe angina, not available for further conventional pharmacological treatment or for revascularization procedures. The aim of the study was to assess fatality, morbidity and quality of life in patients with refractory angina. Methods: Patients with refractory angina were prospectively identified at seven centres and were compared with an age and gender matched group of patients accepted for revascularization due to severe angina. Results: Over three years, 139 patients with refractory angina were identified. The refractory group had more pronounced cardiac disease in terms of more previous myocardial infarctions (p < 0.05), more previous revascularization procedures (p < 0.0001), more severely impaired left ventricular ejection fraction (p < 0.001) as well as higher prevalence of renal dysfunction (p < 0.001) and insulin treated diabetes (p < 0.01) compared to the controls. The refractory patients had a higher one year fatality rate than the control group (10% vs. 0.7%; p < 0.001). Compared to the controls, the refractory group had significantly more impaired quality of life according to the Short Form 36 and the Seattle Angina Questionnaire with regard to physical function, physical well-being and impact of angina symptoms, but there were no differences with regard to mental health and emotional function. Conclusions: Patients with refractory angina pectoris have severe angina symptoms, a more pronounced cardiac disease, a higher fatality rate and a markedly impaired quality of life compared with patients who undergo revascularization procedures due to symptomatic coronary artery disease. Additional symptomatic treatment modalities are highly warranted for this patient group. (C) 2009 Elsevier Ireland Ltd. All rights reserved.