Angina Often Under-Recognized in Stable CAD

Cardiologists often underestimate angina among patients with stable coronary artery disease, the multi-center APPEAR study found.

A notable 42.1% of patients with self-reported angina had physicians under-rate the frequency of their symptoms, Suzanne V. Arnold, MD, MHA, of Saint Luke's Mid America Heart Institute in Kansas City, Mo., and colleagues reported online in Circulation: Cardiovascular Quality and Outcomes.

Most likely to have their angina under-recognized were those with heart failure (OR 3.06, 95% CI 1.89 to 4.95) and monthly angina (OR 1.69, 95% CI 1.12 to 2.56).

Furthermore, "there was large variation across physicians, suggesting some physicians are more accurate in assessing angina than others," according to Arnold's group. "Because the physician's assessment of angina is key in guiding further testing and treatment, under-recognition of the patient's burden of angina could result in undertreatment."

"Under-recognition of angina is common in routine clinical practice," they concluded. "Standardized prospective use of a validated clinical tool, such as the Seattle Angina Questionnaire, should be tested as a means to improve recognition of angina and, potentially, improve appropriate treatment of angina."

"Despite the importance of assessing angina burden in patients with coronary disease," they added, "we still routinely depend solely on an unstructured interview, instead of directly asking patients using standardized assessments."

A total of 1,257 patients were included in Arnold's study, 411 of whom reported angina in the previous month. They saw 155 cardiologists from 25 sites.

Comment