title: A brief cognitive-behavioral intervention reduces hospital admissions in refractory angina patients.
abstract: Chronic refractory angina is an increasingly prevalent, complex chronic pain condition, which results in frequent hospitalization for chest pain. We have previously shown that a novel outpatient cognitive-behavioral chronic disease management program (CB-CDMP) improves angina status and quality of life in such patients. In the present study of 271 chronic refractory angina patients enrolled in our CB-CDMP, total hospital admissions were reduced from 2.40 admissions per patient per year to 1.78 admissions per patient per year (P<0.001). The rising trend of total hospital bed day occupancy prior to enrollment fell from 15.48 days per patient per year to a stable 10.34 days per patient per year (P<0.001). There were 32 recorded myocardial infarctions prior to enrollment compared to eight in the year following enrollment (14% vs. 2.3%, P<0.001) and overall mortality was lower that comparable groups treated with surgery. This study shows that educating patients and demystifying angina using a brief outpatient CB-CDMP produces an immediate and sustained reduction in hospital admission costs that represents a major potential health care saving. This benefit accrues in addition to the known effects of CB-CDMP on symptoms and quality of life. These data suggest that a CB-CDMP approach to symptom palliation represents a low cost alternative to palliative revascularization.
authors.affiliation: Cardiothoracic Center, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.
authors.forename: Roger K G
authors.initials: RK
authors.lastname: Moore
authors.forename: David G
authors.initials: DG
authors.lastname: Groves
authors.forename: John D
authors.initials: JD
authors.lastname: Bridson
authors.forename: Antony D
authors.initials: AD
authors.lastname: Grayson
authors.forename: Helen
authors.initials: H
authors.lastname: Wong
authors.forename: Austin
authors.initials: A
authors.lastname: Leach
authors.forename: Robert J P
authors.initials: RJ
authors.lastname: Lewin
authors.forename: Michael R
authors.initials: MR
authors.lastname: Chester
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000787:Angina Pectoris / Q000401:mortality / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D010148:Intractable Pain / Q000628:therapy*; D010343:Patient Admission / Q000706:statistics & numerical data*; D015397:Program Evaluation