Improvement in quality of life and angina pectoris: 1-year follow-up of patients with refractory angina pectoris and spinal cord stimulation

F E Vervaat, A van der Gaag, H van Suijlekom, C J Botman, K Teeuwen, I Wijnbergen, F E Vervaat, A van der Gaag, H van Suijlekom, C J Botman, K Teeuwen, I Wijnbergen

Abstract

Aims: Spinal cord stimulation (SCS) is a treatment for patients with refractory angina pectoris (RAP) who remain symptomatic despite optimal medical therapy and without revascularisation options. Previous studies have shown that SCS improves the quality of life in this patient group and reduces the severity of the angina pectoris. The aim of this prospective, single-arm observational study is to show this effect in a single-centre cohort using a multidisciplinary team approach to the selection process, with a follow-up period of 1 year.

Methods and results: Between July 2010 and March 2017, 87 patients with RAP referred to our centre received SCS. The Seattle Angina Questionnaire (SAQ) and RAND 36-Item Health Survey (RAND-36) were completed at baseline, prior to implantation, and 1 year post-implantation. After 1 year of follow-up there was a statistically significant decrease in the frequency of angina pectoris attacks from more than 4 times a day to 1-2 times a week (p < 0.001). The SAQ showed statistically significant improvement in four of the five dimensions: physical limitation (p < 0.001), angina frequency (p < 0.001), angina stability (p < 0.001) and quality of life (p < 0.001). The RAND-36 showed statistically significant improvement in all nine dimensions: physical functioning (p = 0.001), role/physical (p < 0.001), social functioning (p = 0.03), role/emotional (p < 0.05), bodily pain (p < 0.001), general health (p < 0.001), vitality (p < 0.001), mental health (p = 0.02) and health change (p < 0.001).

Conclusion: This study showed a significant improvement in quality of life and reduction of angina pectoris severity after 1 year of follow-up in patients treated with SCS for RAP.

Keywords: Refractory angina pectoris; Spinal cord stimulation.

Conflict of interest statement

F.E. Vervaat, A. van der Gaag, H. van Suijlekom, C.J. Botman, K. Teeuwen and I. Wijnbergen declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Selection process. (CCS Canadian Cardiovascular Society, CABG coronary artery bypass graft, PCI percutaneous coronary intervention, TENS transcutaneous electrical nerve stimulation, SCS spinal cord stimulation. aReasons for TENS instead of SCS: patient request (n = 4), comorbidities (n = 5), implantation of SCS device technically unsuccessful (n = 2). bThis group of ten patients includes one patient who did not perform a treadmill stress test due to a lower leg amputation but received TENS during 1 month and continued with this treatment option)
Fig. 2
Fig. 2
Results of Seattle Angina Questionnaire at baseline versus 1 year. (**p < 0.001)
Fig. 3
Fig. 3
a, b Results of RAND 36-Item Health Survey at baseline versus 1 year. (*p < 0.05, **p < 0.001)
Fig. 4
Fig. 4
One-year results of frequency of angina pectoris (a) and frequency of use of short-acting nitrates (b)

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