What does this research mean for the field?

Patients with angina alone have mortality and cardiac event risks similar to those with prior acute myocardial infarction or revascularisation, while experiencing poorer physical functioning. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare the prognosis of patients diagnosed with angina alone to those with a history of acute myocardial infarction and/or revascularisation and/or angina.

July 31, 2008HeartOpen Access

Do patients with angina alone have a more benign prognosis than patients with a history of acute myocardial infarction, revascularisation or both? Findings from a community cohort study

Q: What are the key findings of this study?

Patients with angina alone had a slightly lower risk of all-cause mortality (HR 0.73) compared to those with previous AMI or revascularization, though this was not significant at the p<0.01 level.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Ischaemic heart disease (n=1609). Intervention: Angina alone vs. Previous acute myocardial infarction (AMI) and/or revascularisation. Primary outcome: All-cause mortality (HR 0.73, 95% CI 0.55 to 0.98, p=0.035).

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Key result

Angina alone is linked to ~27% lower all-cause mortality versus prior AMI or revascularization.

HR 0.73
95% CI 0.55 to 0.98
P=0.035
n=1,609

Why the study?

Does a diagnosis of angina alone confer a more benign prognosis for mortality and cardiac outcomes compared to a history of AMI or revascularisation in adults with ischaemic heart disease?

Population

1,609 adults with ischaemic heart disease (IHD) identified from 37 Irish general practices

Comparison

Diagnosis of angina alone vs History of acute myocardial infarction and/or…

Design

Cohort

Follow-up

4.5 years

Authors

BBBrian S BuckleyCochrane AMAndrew W. MurphyOllscoil na Gaillimhe – University of Galway

Discussion

Member takes

Implication

Angina alone signals comparable mortality risk to prior AMI; leaves open whether poorer physical functioning warrants targeted interventions in larger cohorts.

Key Points

To compare the prognosis of patients diagnosed with angina alone to those with a history of acute myocardial infarction and/or revascularisation and/or angina.
Conducted a community-based retrospective cohort study across a random selection of 37 Irish general practices involving 1,609 adults with ischaemic heart disease identified in 2000/1.
Assessed outcomes via medical record searches and postal questionnaires in 2000/1 and 2005/6 across an average follow-up of 4.5 years.
Analyzed primary outcomes of all-cause and ischaemic heart disease-related mortality alongside secondary outcomes including subsequent AMI, CABG, PTCA, and SF36/SF12 physical and mental health status.
Compared with patients with previous AMI and/or revascularisation, patients with angina alone showed HR 0.73 (95% CI 0.55 to 0.98; p=0.035) for all-cause death and HR 0.65 (95% CI 0.44 to 0.98; p=0.038) for IHD-related death, which were not significant at the recommended p<0.01 threshold.
Proportional hazards models identified no statistically significant differences in adjusted risks of subsequent AMI, CABG, or PTCA between patients with angina alone and those with other ischaemic heart disease.
Physical functioning was consistently lower among individuals with angina alone across the 4.5-year follow-up, showing a slightly greater rate of functional impairment over time.

Study Design

Type

Cohort (n=1,609)

Multicenter

Yes

Structured PICO

Does a diagnosis of angina alone confer a more benign prognosis for mortality and cardiac outcomes compared to a history of AMI or revascularisation in adults with ischaemic heart disease?

Population

1,609 adults under 80 years of age with ischaemic heart disease from 37 general practices, followed for an average of 4.5 years.

Exposure

Diagnosis of angina alone

Comparator

History of acute myocardial infarction (AMI) and/or revascularisation

Outcome

All-cause and IHD-related mortalityhard clinical

Main Result

Hazard Ratio: 0.73 (95% CI 0.55–0.98)

p-value: p=0.035

Patients with angina alone have a similar prognosis for death or cardiac outcomes compared to those with previous AMI or revascularisation, but experience poorer physical health status, highlighting the clinical importance of angina in primary care.

Limitations

Potential ascertainment bias as patients with angina only may be more likely to remain unidentified
Absence of any measurement of disease severity
Variable diagnostic standards for angina in primary care
Potential information bias from self-reported data and medical records
The cohort was 100% white, limiting generalizability
Conducted in a specific rural/urban region in Ireland without large European-scale cities

Cite This Study

Buckley et al. (2008) conducted a cohort in Ischaemic heart disease (n=1,609). Angina alone vs. Previous acute myocardial infarction (AMI) and/or revascularisation was evaluated on All-cause mortality (HR 0.73, 95% CI 0.55 to 0.98, p=0.035). Patients with angina alone had a slightly lower risk of all-cause mortality (HR 0.73) compared to those with previous AMI or revascularization, though this was not significant at the p<0.01 level.

synapsesocial.com/papers/6a2005ddd40b4a263065b310 https://doi.org/10.1136/hrt.2008.146944

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Implication

Angina alone signals comparable mortality risk to prior AMI; leaves open whether poorer physical functioning warrants targeted interventions in larger cohorts.

Do patients with angina alone have a more benign prognosis than patients with a history of acute myocardial infarction, revascularisation or both? Findings from a community cohort study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Do patients with angina alone have a more benign prognosis than patients with a history of acute myocardial infarction, revascularisation or both? Findings from a community cohort study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider