Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography: a randomised controlled trial

Williams, M. C. et al. (2017) Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography: a randomised controlled trial. Heart, 103(13), pp. 995-1001. (doi: 10.1136/heartjnl-2016-310129) (PMID:28246175) (PMCID:PMC5529983)

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Background: In patients with suspected angina pectoris, CT coronary angiography (CTCA) clarifies the diagnosis, directs appropriate investigations and therapies, and reduces clinical events. The effect on patient symptoms is currently unknown. Methods: In a prospective open-label parallel group multicentre randomised controlled trial, 4146 patients with suspected angina due to coronary heart disease were randomised 1:1 to receive standard care or standard care plus CTCA. Symptoms and quality of life were assessed over 6 months using the Seattle Angina Questionnaire and Short Form 12. Results: Baseline scores indicated mild physical limitation (74±0.4), moderate angina stability (44±0.4), modest angina frequency (68±0.4), excellent treatment satisfaction (92±0.2) and moderate impairment of quality of life (55±0.3). Compared with standard care alone, CTCA was associated with less marked improvements in physical limitation (difference −1.74 (95% CIs, −3.34 to −0.14), p=0.0329), angina frequency (difference −1.55 (−2.85 to −0.25), p=0.0198) and quality of life (difference −3.48 (−4.95 to −2.01), p<0.0001) at 6 months. For patients undergoing CTCA, improvements in symptoms were greatest in those diagnosed with normal coronary arteries or who had their preventative therapy discontinued, and least in those with moderate non-obstructive disease or had a new prescription of preventative therapy (p<0.001 for all). Conclusions: While improving diagnosis, treatment and outcome, CTCA is associated with a small attenuation of the improvements in symptoms and quality of life due to the detection of moderate non-obstructive coronary artery disease. Trial registration number: NCT01149590.

Item Type:Articles
Additional Information:This trial was funded by The Chief Scientist Office of the Scottish Government Health and Social Care Directorates (CZH/4/588), with supplementary awards from Edinburgh and Lothian’s Health Foundation Trust and the Heart Diseases Research Fund.
Glasgow Author(s) Enlighten ID:Mangion, Dr Kenneth and Newby, Professor David and Roditi, Dr Giles and Berry, Professor Colin
Authors: Williams, M. C., Hunter, A., Shah, A., Assi, V., Lewis, S., Mangion, K., Berry, C., Boon, N. A., Clark, E., Flather, M., Forbes, J., McLean, S., Roditi, G., van Beek, E. J.R., Timmis, A. D., and Newby, D. E.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN (Online):1468-201X
Published Online:28 February 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Heart 103(13): 995-1001
Publisher Policy:Reproduced under a Creative Commons license

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