Ranolazine: impact on quality of life in patients with stable angina pectoris, results from an observational study in Austria – the ARETHA AT study

OBJECTIVE: Assessment of treatment routine and outcome for ranolazine in clinical practice as second-line treatment for stable angina pectoris (AP). DESIGN AND SETTING: Multicenter, prospective, uncontrolled, non-interventional study at 88 sites including internal specialists, cardiologists, pneumologists, angiologists and primary care practices in Austria. PARTICIPANTS: In this study 292 patients receiving ranolazine in the course of routine treatment on top of beta blockers or calcium channel blockers after failure of first-line therapy. MAIN OUTCOME MEASURES: Dosage and symptoms were recorded at two visits (at intervals of 12 weeks), complemented by treatment rationale and disease characteristics at baseline. Disease intensity was quantified by angina symptoms, nitrate use and by Canadian Cardiovascular Society (CCS) grading. Quality of life (QoL) was assessed through a 10-grade scale. Data were analyzed by descriptive statistics. RESULTS: Ranolazine was prescribed in order to improve exercise capacity (84.3%), reduce symptoms (83.2%) and reduce AP (77.1%). Of the patients 87.3% received the recommended starting dose of 375 mg and subsequent dose changes were reported for 39.8%. The number of AP attacks was reduced from 5.3 ± 4.5 to 0.8 ± 1.3 per week; nitrate use was reduced from 3.4 ± 4.1 to 0.4 ± 0.9 applications per week. Of the patients 94.0% reported improved exercise capacity and 93.7% reduced symptoms. For the majority of patients, the CCS improved from grade II to I and QoL improved accordingly. Of the patients 3 experienced adverse drug reactions and 95.5% continued ranolazine. CONCLUSION: In this real-world study, ranolazine was shown to be effective, safe and well tolerable. Symptoms of AP were improved, as illustrated by the reduced number of angina attacks, reduced rate of nitrate use, reduced CCS scores and improved QoL.