Cheng Kevin, de Silva Ranil
Honorary Clinical Research Fellow National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP.
Senior Clinical Lecturer, Honorary Consultant Cardiologist National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP.
Br J Cardiol. 2020 May 20;27(2):12. doi: 10.5837/bjc.2020.012. eCollection 2020.
Refractory angina (RA) is a growing clinical problem. Long-term mortality is better than expected and focus has shifted to improving symptoms, quality of life and psychological morbidity. We established a dedicated multi-disciplinary care pathway for patients with RA and assessed its effect on psychological outcomes, quality of life and polypharmacy. We reviewed electronic health records to capture demographics, changes in medication use, and patient-related outcome measures (Seattle Angina Questionnaire [SAQ] and Hospital Anxiety and Depression Scale) before and after enrolment. One hundred and ninety patients were referred to our service. Pre- and post-questionnaire data were available in 83 patients. Anxiety and depression scores significantly improved (p<0.05) as well as quality of life and all subcategories of the SAQ (p<0.0001). Patients were most commonly on three or four anti-anginal drugs. In patients with no demonstrable reversible ischaemia, there was a significant reduction in anti-anginal usage (mean reduction of two drugs) after completion of our pathway (p<0.025). In conclusion, a dedicated multi-disciplinary pathway for RA is associated with improvements in quality of life, mental health and polypharmacy. An ischaemia-driven method to rationalise medication may reduce polypharmacy in patients with RA, particularly in patients with no demonstrable ischaemia.
难治性心绞痛（RA）是一个日益严重的临床问题。其长期死亡率好于预期，关注点已转向改善症状、生活质量和心理疾病。我们为RA患者建立了专门的多学科护理路径，并评估了其对心理结局、生活质量和联合用药的影响。我们回顾了电子健康记录，以获取患者的人口统计学信息、用药变化以及入组前后与患者相关的结局指标（西雅图心绞痛问卷[SAQ]和医院焦虑抑郁量表）。190名患者被转诊至我们的科室。83名患者有问卷前后的数据。焦虑和抑郁评分显著改善（p<0.05），生活质量和SAQ的所有子类别也显著改善（p<0.0001）。患者最常使用三或四种抗心绞痛药物。在没有可证实的可逆性缺血的患者中，完成我们的护理路径后，抗心绞痛药物的使用显著减少（平均减少两种药物）（p<0.025）。总之，RA的专门多学科护理路径与生活质量、心理健康和联合用药的改善相关。一种基于缺血情况来合理用药的方法可能会减少RA患者的联合用药，尤其是在没有可证实缺血的患者中。
