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Characteristics of a contemporary population with angina pectoris. TIDES Investigators
C J Pepine1, J Abrams, R G Marks
1Department of Medicine, University of Florida, Gainesville.
Insights
This study of chronic stable angina patients found that women and elderly individuals frequently experience rest and mental stress-induced angina, often alongside other illnesses and multiple medications. Increased angina frequency negatively impacts well-being.
Area of Science:
- Cardiology
- Primary Care Medicine
- Epidemiology
Background:
- Angina pectoris affects a significant population, with limited characterization of contemporary, non-hospitalized patients.
- Understanding the profile of outpatients with chronic stable angina is crucial for effective management.
Purpose of the Study:
- To characterize a contemporary, geographically diverse cohort of 5,125 outpatients diagnosed with chronic stable angina.
- To identify factors associated with rest angina and mental stress-evoked angina in this population.
Main Methods:
- Data collected from 1,266 primary care physicians between September and November 1990.
- Diagnosis of chronic stable angina based on history and evidence of coronary artery disease (coronary angiography, myocardial infarction, or abnormal stress test).
Main Results:
- The cohort comprised 5,125 outpatients (mean age 69 years, 53% women) with chronic stable angina.
- 70% had >1 comorbidity, 64% used >1 cardiovascular drug.
- Increased angina frequency correlated with decreased well-being (p < 0.0001).
- Rest angina present in 47%, mental stress angina in 35%.
- Female gender, comorbidity, and pharmacotherapy were associated with increased risk for rest and mental stress angina.
Conclusions:
- Contemporary outpatients with angina are often elderly women with multiple comorbidities.
- Rest and mental stress-induced angina are prevalent in this population.
- These findings highlight the complex management needs of chronic stable angina patients in primary care settings.
Abstract:
To characterize a contemporary, nonhospitalized population with angina pectoris, data were obtained from a geographically diverse cohort of 5,125 outpatients with chronic stable angina cared for by 1,266 primary care physicians between September and November of 1990. Diagnosis was based on history supported by evidence for coronary artery disease (coronary angiography, old myocardial infarction, or an abnormal stress test, either alone or in combination). The mean age of the patients was 69 years and 53% were women. Seventy percent had > 1 associated illness and 64% took > 1 cardiovascular drug. Median angina frequency was approximately 2 episodes/week and increased angina frequency (p < 0.0001) was associated with decreased overall feeling of well-being. Although effort angina was present in 90% of patients, 47% also had rest angina and 35% had mental stress-evoked angina. Female gender (relative risk [RR] 1.09; 95% confidence interval [CI] 1.02 to 1.16), concomitant illness (RR 1.17; CI 1.09 to 1.25), and pharmacotherapy (RR 1.14; CI 1.07 to 1.22) were associated with excess risk for rest angina. Younger age (RR 1.30; CI 1.20 to 1.41), female gender (RR 1.16; CI 1.07 to 1.26), concomitant illness (RR 1.13; CI 1.03 to 1.24), and pharmacotherapy (RR 1.28; CI 1.15 to 1.93) were associated with excess risk for mental stress angina. These data suggest that contemporary outpatients with angina are frequently women and elderly patients with high rates of associated illness, rest, and mental stress-related angina.