Management of Stable Angina Pectoris in Private Healthcare Settings in South Africa

Overview

Journal Cardiovasc J Afr

Specialty Cardiology & Vascular Diseases

Date 2018 Aug 29

PMID 30152841

Authors

Pride Tlhakudi

Lehlohonolo John Mathibe

Affiliations

Soon will be listed here.

Abstract

Aim: Angina pectoris continues to affect multitudes of people around the world. In this study the management of stable angina pectoris in private healthcare settings in South Africa (SA) was investigated. In particular, we reviewed the frequency of medical versus surgical interventions when used as first-line therapy.

Methods: This was a retrospective inferential study carried out using records of patients in private healthcare settings. All cases that were authorised for reimbursement by medical aid schemes for revascularisation between 2009 and 2014 were retrieved and a database was created. Data were analysed using Microsoft Excel and GraphPad Prism version 5. The differences (where applicable) were considered statistically significant if the -value was ≤ 0.05.

Results: Nine hundred and twenty-two patients, consisting of 585 males (average age 64.7 years; SD 12.9) and 337 females (average age 65.5 years; SD 14.3), met the inclusion criteria. One hundred and seventy-eighty or 54%, 156 (43%) and 86 (63%) patients with hypertension, hyperlipidaemia and diabetes, respectively, were treated with surgery only. For these patients, percutaneous coronary interventions (PCIs) were significantly ( < 0.0001) preferred first-line interventions over optimal medical therapy (OMT). Four hundred and thirty-six or 47% of all patients studied were managed with surgery only, while only 25% (227) were managed with OMT. It took 60 months (five years) for patients who were treated with OMT before their first surgical intervention(s) to require the second revascularisation. About 71% of patients who received medical therapy were placed on only one drug, the so called sub-optimal medical therapy (SOMT).

Conclusions: The management of stable angina pectoris in private healthcare settings in SA is skewed towards surgical interventions as opposed to OMT. This is contrary to what consistent scientific evidence and international treatment guidelines suggest.

References

Malhotra A . The whole truth about coronary stents: the elephant in the room. JAMA Intern Med. 2014; 174(8):1367-8. DOI: 10.1001/jamainternmed.2013.9190. View

Foucrier A, Rodseth R, Aissaoui M, Ibanes C, Goarin J, Landais P . The long-term impact of early cardiovascular therapy intensification for postoperative troponin elevation after major vascular surgery. Anesth Analg. 2014; 119(5):1053-63. DOI: 10.1213/ANE.0000000000000302. View

Bodenheimer T . The American health care system--the movement for improved quality in health care. N Engl J Med. 1999; 340(6):488-92. DOI: 10.1056/NEJM199902113400621. View

. Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet. 2002; 359(9314):1269-75. DOI: 10.1016/S0140-6736(02)08265-X. View

Pepine C, Wolff A . A controlled trial with a novel anti-ischemic agent, ranolazine, in chronic stable angina pectoris that is responsive to conventional antianginal agents. Ranolazine Study Group. Am J Cardiol. 1999; 84(1):46-50. DOI: 10.1016/s0002-9149(99)00190-3. View

Thadani U . Management of Stable Angina - Current Guidelines: A Critical Appraisal. Cardiovasc Drugs Ther. 2016; 30(4):419-426. DOI: 10.1007/s10557-016-6681-2. View

Mohee K, Wheatcroft S . Optimal medical therapy and percutaneous coronary intervention for stable angina: why patients should 'be taking' and 'keep taking' the tablets. J Clin Pharm Ther. 2014; 39(4):331-3. DOI: 10.1111/jcpt.12164. View

Boden W, ORourke R, Teo K, Hartigan P, Maron D, Kostuk W . Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007; 356(15):1503-16. DOI: 10.1056/NEJMoa070829. View

Ilashchuk T, Glubochenko O, Senyuk B, Bachuk-Ponich N, Lukashevich I . INFLUENCE OF BETA-BLOCKERS AND IVABRADINE ON LONG-TERM PROGNOSIS OF PATIENTS WITH STABLE ANGINA. Georgian Med News. 2017; (267):57-61. View

10.

Braunwald E, Morrow D . Unstable angina: is it time for a requiem?. Circulation. 2013; 127(24):2452-7. DOI: 10.1161/CIRCULATIONAHA.113.001258. View

11.

Gaziano T, Bitton A, Anand S, Abrahams-Gessel S, Murphy A . Growing epidemic of coronary heart disease in low- and middle-income countries. Curr Probl Cardiol. 2010; 35(2):72-115. PMC: 2864143. DOI: 10.1016/j.cpcardiol.2009.10.002. View

12.

Leek J, Peng R . Statistics. What is the question?. Science. 2015; 347(6228):1314-5. DOI: 10.1126/science.aaa6146. View

13.

Anderson J, Adams C, Antman E, Bridges C, Califf R, Casey Jr D . 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart.... Circulation. 2013; 127(23):e663-828. DOI: 10.1161/CIR.0b013e31828478ac. View

14.

Al-Lamee R, Davies J, Malik I . What is the role of coronary angioplasty and stenting in stable angina?. BMJ. 2016; 352:i205. DOI: 10.1136/bmj.i205. View

15.

Siama K, Tousoulis D, Papageorgiou N, Siasos G, Tsiamis E, Bakogiannis C . Stable angina pectoris: current medical treatment. Curr Pharm Des. 2012; 19(9):1569-80. View

16.

Feldman D, Gade C, Slotwiner A, Parikh M, Bergman G, Wong S . Comparison of outcomes of percutaneous coronary interventions in patients of three age groups (<60, 60 to 80, and >80 years) (from the New York State Angioplasty Registry). Am J Cardiol. 2006; 98(10):1334-9. DOI: 10.1016/j.amjcard.2006.06.026. View

17.

Iqbal J, Widmer R, Gersh B . State of the art: optimal medical therapy - competing with or complementary to revascularisation in patients with coronary artery disease?. EuroIntervention. 2017; 13(6):751-759. DOI: 10.4244/EIJ-D-17-00463. View

18.

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V . Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859):2095-128. PMC: 10790329. DOI: 10.1016/S0140-6736(12)61728-0. View

19.

Mozaffarian D, Benjamin E, Go A, Arnett D, Blaha M, Cushman M . Executive Summary: Heart Disease and Stroke Statistics--2016 Update: A Report From the American Heart Association. Circulation. 2016; 133(4):447-54. DOI: 10.1161/CIR.0000000000000366. View

20.

Ohman E . CLINICAL PRACTICE. Chronic Stable Angina. N Engl J Med. 2016; 374(12):1167-76. DOI: 10.1056/NEJMcp1502240. View