Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain

Abstract

Background: Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD.

Methods: From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale.

Results: Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, respectively. Patients with typical angina had the poorest physical functioning compared to the other angina groups (SF-12 physical component score; 41.2 ± 8.8, 43.3 ± 9.1, 46.2 ± 9.0, 46.4 ± 11.4, respectively, all age and gender-adjusted p < 0.01), and highest anxiety levels (8.3 ± 4.1, 7.5 ± 4.1, 6.5 ± 4.0, 4.7 ± 4.5, respectively, all adjusted p < 0.01). On all other measures, patients with typical or atypical angina had lower HRQoL compared to the two other groups (all adjusted p < 0.05). HRQoL did not differ between patients with and without obstructive CAD while women had worse HRQoL compared with men, irrespective of age and angina type.

Conclusions: Prior to a diagnostic procedure for stable chest pain, HRQoL is associated with chest pain characteristics, but not with obstructive CAD, and is significantly lower in women.

Trial registration: Clinicaltrials.gov, NCT02400229.

Keywords: Angina; Chest pain; Computed tomography angiography; Coronary artery disease; Health-related quality of life; Invasive coronary angiography.

Conflict of interest statement

AN reports grants from Siemens Medical Solutions, grants from GE Healthcare, grants from Toshiba Medical Systems, grants from Philips Medical Systems, outside the submitted work.

TE reports personal fees from Boston, personal fees from Bayer, personal fees from Abbott, personal fees from Medtronic, personal fees from Novo, outside the submitted work.

KFK reports grants from Canon Medical Corporation, grants from AP Møller og hustru Chastine McKinney Møllers Fond, grants from The Danish Heart Foundation, outside the submitted work.

JDD is an associate editor of Radiology, European Radiology, Quarterly Journal of Medicine and Respirology.

JK reports personal fees from GE Healthcare, personal fees from AstraZeneca, outside the submitted work.

AS reports grants from Academy of Finland, grants from Finnish Foundation for Heart Research, personal fees from Astra Zeneca, personal fees from Bayer, personal fees from Abbott, personal fees from Novartis, outside the submitted work; .

ANN reports grants from Ministry of Education, Science and Technological Development, Government of the Republic of Serbia, from null, during the conduct of the study.

MD reports grant support from the FP7 Program of the European Commission for the randomized multicenter DISCHARGE trial (603266–2, HEALTH-2012.2.4.-2), from the Heisenberg Program of the DFG (DE 1361/14–1), from the Digital Health Accelerator of the Berlin Institute of Health, and the DFG graduate program on quantitative biomedical imaging (BIOQIC, GRK 2260/1), personal fees from Canon Medical Systems, Guerbet, Cardiac MR Academy Berlin, and Bayer. He is also the editor of Cardiac CT, published by Springer, and offers hands-on workshops on CT imaging (www.ct-kurs.de). Institutional master research agreements exist with Siemens Medical Solutions, General Electric, Philips Medical Systems, and Toshiba Medical Systems. The terms of these arrangements are managed by the legal department of Charité – Universitätsmedizin Berlin.

All other authors report no competing interests.

Figures

Fig. 1

Patient flow-chart

Fig. 2

Health-related quality of life in (a) angina groups and (b) patients with and without CAD. For graphic display, measures were standardized such that the minimum observation of all measures corresponds to 0 and the maximum observation to 100. CAD, Coronary artery disease; HADS, Hospital anxiety and depression scale; VAS, visual analogue scale

Fig. 3

Percentage of patients with some or moderate / extreme problems in EuroQol problem dimensions. Problem dimensions from the EuroQol (EQ-5D-3 L). Groups refer to: 1 = Typical angina pectoris, 2 = Atypical angina pectoris, 3 = Non-anginal chest discomfort and 4 = Other chest discomfort

Fig. 4

Summary of health-related quality of life differences between women and men. For graphic display, measures were standardized such that the minimum observation of all measures corresponds to 0 and the maximum observation to 100. HADS, Hospital anxiety and depression scale; VAS, visual analogue scale