96 The impact of a multi-disciplinary care pathway for patients with refractory angina on psychosocial outcomes, quality of life and medication
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".