Management of patients with refractory angina: Canadian Cardiovascular Society/Canadian Pain Society joint guidelines

Can J Cardiol. 2012 Mar-Apr;28(2 Suppl):S20-41. doi: 10.1016/j.cjca.2011.07.007.

Abstract

Refractory angina (RFA) is a debilitating disease characterized by cardiac pain resistant to conventional treatments for coronary artery disease including nitrates, calcium-channel and β-adrenoceptor blockade, vasculoprotective agents, percutaneous coronary interventions, and coronary artery bypass grafting. The mortality rate of patients living with RFA is not known but is thought to be in the range of approximately 3%. These individuals suffer severely impaired health-related quality of life with recurrent and sustained pain, poor general health status, psychological distress, impaired role functioning, and activity restriction. Effective care for RFA sufferers in Canada is critically underdeveloped. These guidelines are predicated upon a 2009 Canadian Cardiovascular Society (CCS) Position Statement which identified that underlying the problem of RFA management is the lack of a formalized, coordinated, interprofessional strategy between the cardiovascular and pain science/clinical communities. The guidelines are therefore a joint initiative of the CCS and the Canadian Pain Society (CPS) and make practice recommendations about treatment options for RFA that are based on the best available evidence. Concluding summary recommendations are also made, giving direction to future clinical practice and research on RFA management in Canada.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Angina Pectoris* / diagnosis
  • Angina Pectoris* / etiology
  • Angina Pectoris* / physiopathology
  • Angina Pectoris* / therapy
  • Canada
  • Cardiovascular Agents / therapeutic use*
  • Disease Management*
  • Humans
  • Meta-Analysis as Topic
  • Myocardial Revascularization* / adverse effects
  • Myocardial Revascularization* / methods
  • Outcome and Process Assessment, Health Care
  • Pain, Intractable* / complications
  • Pain, Intractable* / physiopathology
  • Patient Care Team / organization & administration
  • Quality Indicators, Health Care
  • Safety Management / standards
  • Secondary Prevention
  • Self Care / methods*
  • Sickness Impact Profile
  • Societies, Medical
  • Stress, Psychological / etiology

Substances

  • Cardiovascular Agents