96 The impact of a multi-disciplinary care pathway for patients with refractory angina on psychosocial outcomes, quality of life and medication
Notice bibliographique
Résumé
Introduction Refractory angina (RA) is a growing clinical problem due to improved survival from coronary artery disease (CAD) and an ageing population. These no option patients experience chronic angina-type pain, in the context of CAD, despite optimal medical and revascularisation therapies. Consequently, management of these patients is challenging and outcomes remain suboptimal. As mortality is no worse, the focus of treatment has shifted to improving symptoms, quality of life (QoL) and psychosocial outcomes. Methods We undertook a single-centre study of the impact of a multi-disciplinary care pathway (Figure 1) on psychosocial outcomes, QoL and changes in cardiovascular medications. We performed a retrospective search of Electronic Patient Records and databases at the Royal Brompton Hospital for all patients with RA seen between 23/01/2003 and 06/06/2016. Data collected included pre- and post-intervention Hospital Anxiety and Depression Scale and Seattle Angina Questionnaire scores, use of the Angina Plan, referral for specialist pain management and alterations in cardiovascular medications. Median scores and differences for anxiety, depression and QoL were analysed using Wilcoxon matched-pairs signed rank tests. Chi-squared tests were used to assess medication changes. Statistical significance was p < 0.05 . Results A total of 190 patients with RA were included. The Angina Plan was used in 80.5% (n=153) and 38.9% (n=74) patients were referred to pain clinic. Comparison of pre- and post-intervention scores (Table 1) showed significant improvements in anxiety (p = 0.0005 ), depression (p = 0.0469 ), and QoL including physical limitation, frequency and perception of angina symptoms and treatment satisfaction (all p < 0.0001 ) (Figure 2). Nicorandil use was reduced (p < 0.05 ) and ivabradine and ranolazine increased (p < 0.0001 ). Other anti-anginal (ß-blockers, calcium channel blockers, long-acting nitrates) and disease modifying drugs (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, antiplatelets) were unchanged (p > 0.05 ) (Table 2). Conclusions In this study, we showed that a multi-disciplinary care pathway for patients with RA can significantly improve psychosocial outcomes, QoL and medication use. Furthermore, the rate of use of the Angina Plan was high, emphasising the benefits of this specialist nurse-delivered cognitive behavioural therapy-based rehabilitation program in the management of RA. Conventional anti-anginal medication use was largely unchanged or reduced (52.8% of patients), in keeping with a non-cardiac aetiology for a proportion of patients symptoms. Ivabradine and ranolazine increased, associated with their introduction to the market. Few data demonstrate the potential impact of specialist services for patients with RA in improving QoL and psychosocial wellbeing, which are the management priorities in this challenging patient group. Our findings suggest that further work in this area is warranted.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».