Characteristics, treatment and quality of life of stable coronary artery disease patients with or without angina: Insights from the START study

Abstract

Data on contemporary management patterns of angina in patients with stable coronary artery disease (CAD) are scarce. We sought to describe the current presentation, management, and quality of life of stable CAD patients with or without angina, using the data from the START (STable Coronary Artery Diseases RegisTry) study. START was a prospective, observational, nationwide study aimed to evaluate the presentation, management, treatment and quality of life of stable CAD presenting to cardiologists during outpatient visits or discharged from cardiology wards. Among the 5070 consecutive stable CAD patients enrolled in 183 participating centers over a 3-month period, 3714 (73.2%) had no angina and 1356 (26.8%) presented with angina. Patients with angina underwent more frequently coronary angiography (92.7% vs 84.9%; p<0.0001) and other diagnostic imaging procedures compared to those without angina. In addition, patients with angina received more frequently different combinations of first line therapies and angina relief drugs compared to patients without angina. The quality of life, assessed with the EQ 5D-5L questionnaire, did not differ between the two groups, with the exception of the 'pain or worry' domain that was higher in patients with compared to those without angina (p<0.0001). Current management and treatment of stable CAD patients with angina is still suboptimal and different compared to those without angina. Our findings highlight the need for disseminating best-practice patterns and improving guidelines adherence for the management of angina even among cardiologists.

Conflict of interest statement

Dr. De Luca and Dr. Temporelli report personal fees from Menarini, outside the submitted work; Lucci is an employee of Heart Care Foundation, which conducted the study with an unresctricted grant of research from Menarini, Italy. These commenrcial fundings do not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Figures

Fig 1. Cardiovascular drugs† prescribed at the end of the visit or at hospital discharge in patients with and without angina.

†Drugs not reported have been used in less than 5% of cases. ACE-I: angiotensin converting enzyme inhibitors; ARB: angiotensin receptor blockers; ASA: acetylsalicylic acid; DAPT: dual antiplatelet therapy; MRA: mineralocorticoid receptor antagonist; OAT: oral anticoagulation therapy.

Fig 2. Use of combinations of angina relief drugs in patients with and without angina.

βB: beta-blockers; CCBs: calcium channel blockers.

Fig 3

Domain of movement ability (panel A), body care (panel B), daily activities (panel C), pain/worry (panel D), and anxiety/depression (panel E) of the EQ 5D-5L questionnaire in patients with and without angina.