Can improved quality of care reduce the costs of managing angina pectoris?

Angina pectoris is a common symptom in patients over 50 years and is usually secondary to myocardial ischaemia resulting from coronary artery disease. The management of angina should be aimed at the maintenance or improvement of quality of life and delaying death. There are three strategies that may be adopted: medical, percutaneous transluminal coronary angioplasty and surgery. The majority of patients with angina can be controlled symptomatically most of the time by medical treatment alone. Any assessment of cost of treatment must take into account the cost of investigation, treatment, the morbidity associated with procedures or side effects of drugs, together with that of recurrent hospitalization, prolonged life and premature death. In addition, the duration of treatment has a major bearing on cost. Taking these factors into account, medical therapy is the least expensive short- and longterm treatment for angina pectoris. A medical approach to treatment also has considerable advantages over an interventional approach in terms of major morbidity. Only one of six surgical trials has demonstrated a survival benefit.