The clinical characteristics and investigations planned in patients with stable angina presenting to cardiologists in Europe: from the Euro Heart Survey of Stable Angina

被引:122
作者
Daly, CA
Clemens, F
Sendon, JLL
Tavazzi, L
Boersma, E
Danchin, N
Delahaye, F
Gitt, A
Julian, D
Mulcahy, D
Ruzyllo, W
Thygesen, K
Verheugt, F
Fox, KM
机构
[1] Royal Brompton & Harefield NHS Trust, London SW3 6NP, England
[2] London Sch Hyg & Trop Med, London WC1, England
[3] Hosp Univ Gregorio Maranon, Madrid, Spain
[4] Policlin San Matteo, I-27100 Pavia, Italy
[5] Erasmus MC, Dept Cardiol, Rotterdam, Netherlands
[6] Hop Europeen Georges Pompidou, Paris, France
[7] Hop Cardiovasc & Pneumol Louis Pradel, Lyon, France
[8] Herzzentrum Ludwigshafen, Ludwigshafen, Germany
[9] Newcastle Univ, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England
[10] Adelide & Meath Inc Natl Childrens Hosp, Dublin, Ireland
[11] Inst Cardiol, Warsaw, Poland
[12] Aarhus Univ Hosp, DK-8000 Aarhus, Denmark
[13] Univ St Radboud, Ctr Med, Nijmegen, Netherlands
关键词
stable angina; presentation; cardiovascular risk factors; non-invasive investigation; stress testing; coronary angiography;
D O I
10.1093/eurheartj/ehi171
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims The Euro Heart Survey of Stable Angina set out to prospectively study the presentation and management of patients with stable angina as first seen by a cardiologist in Europe, with particular reference to adherence to existing guidelines and regional variability in patient presentation and initial assessment. Methods and results Consecutive outpatients with a clinical diagnosis by a cardiologist of stable angina were enrolled in the study and 3779 patients were included in the analysis. The average age was 61 years and 58% were male. The majority of patients (88%) had mild to moderate angina, CCS class I or II. Despite a high prevalence of recognized risk factors, 27% did not have cholesterol and 33% did not have glucose measured within 4 weeks of assessment. The resting ECG was abnormal in 41% of patients. An exercise ECG was performed or planned as part of initial investigation in 76% of patients and 18% had a stress imaging test such as perfusion scanning or stress echo. A coronary angiogram was performed or planned in 41%, and 64% had an echo. The time from assessment to investigation varied widely, particularly for angiography. One in 10 patients had neither any form of stress test nor angiography,with marked regional variation. Availability of invasive facilities increased the likelihood 14 of both non-invasive and invasive investigations. Those with more severe symptoms or longer duration of symptoms or a positive non-invasive test were more likely to have 14 angiography. In multivariable analysis, a positive stress test was the strongest predictor of the use of angiography, associated with a six-fold increase in the likelihood of invasive investigation. However, gender and availability of facilities were also predictive. Conclusion Considerable variation in features at presentation and use of investigations has been identified in the stable angina population in Europe. The evaluation of biochemical cardiovascular risk factors was suboptimal. Overall rates of non-invasive investigation for angina and the clinical appropriateness of factors predictive of the use of invasive investigation were broadly in line with guidelines. However, the influence of access to facilities, and marked international variation in rates and timing of investigation suggest that factors unrelated to clinical need are also influential in the management of patients with stable angina.
引用
收藏
页码:996 / 1010
页数:15
相关论文
共 51 条
  • [41] SMITH W, 1990, BRIT HEART J, V65, P344
  • [42] Determinants of use of outcomes of invasive coronary procedures in acute coronary syndromes: results from ENACT
    Steg, PG
    Iung, B
    Feldman, LJ
    Maggioni, AP
    Keil, U
    Deckers, J
    Cokkinos, D
    Fox, KAA
    [J]. EUROPEAN HEART JOURNAL, 2003, 24 (07) : 613 - 622
  • [43] Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE)
    Steg, PG
    Goldberg, RJ
    Gore, JM
    Fox, KAA
    Eagle, KA
    Flather, MD
    Sadiq, I
    Kasper, R
    Rushton-Mellor, SK
    Anderson, FA
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 2002, 90 (04) : 358 - 363
  • [44] CHEST PAIN IN WOMEN - CLINICAL, INVESTIGATIVE, AND PROGNOSTIC FEATURES
    SULLIVAN, AK
    HOLDRIGHT, DR
    WRIGHT, CA
    SPARROW, JL
    CUNNINGHAM, D
    FOX, KM
    [J]. BRITISH MEDICAL JOURNAL, 1994, 308 (6933) : 883 - 886
  • [45] SEX BIAS IN CONSIDERING CORONARY-BYPASS SURGERY
    TOBIN, JN
    WASSERTHEILSMOLLER, S
    WEXLER, JP
    STEINGART, RM
    BUDNER, N
    LENSE, L
    WACHSPRESS, J
    [J]. ANNALS OF INTERNAL MEDICINE, 1987, 107 (01) : 19 - 25
  • [46] Gender differences in diagnosis and treatment of coronary artery disease from 1981 to 1997 - No evidence for the Yentl syndrome
    van Lennep, JER
    Zwinderman, AH
    van Lennep, HWOR
    Westerveld, HE
    Plokker, HWM
    Voors, AA
    Bruschke, AVG
    van der Wall, EE
    [J]. EUROPEAN HEART JOURNAL, 2000, 21 (11) : 911 - 918
  • [47] The East-West life expectancy gap: Differences in mortality from conditions amenable to medical intervention
    Velkova, A
    WolleswinkelvandenBosch, JH
    Mackenbach, JP
    [J]. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 1997, 26 (01) : 75 - 84
  • [48] The impact of diagnostic testing on therapeutic interventions
    Verrilli, D
    Welch, HG
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 275 (15): : 1189 - 1191
  • [49] LONG-TERM PROGNOSTIC VALUE OF EXERCISE TESTING IN MEN AND WOMEN FROM THE CORONARY-ARTERY SURGERY STUDY (CASS) REGISTRY
    WEINER, DA
    RYAN, TJ
    PARSONS, L
    FISHER, LD
    CHAITMAN, BR
    SHEFFIELD, LT
    TRISTANI, FE
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 1995, 75 (14) : 865 - 870
  • [50] MEDICAL COSTS OF CORONARY-ARTERY DISEASE IN THE UNITED-STATES
    WITTELS, EH
    HAY, JW
    GOTTO, AM
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 1990, 65 (07) : 432 - 440