title: Fatality, morbidity and quality of life in patients with refractory angina pectoris.
abstract: BACKGROUND
  Refractory angina pectoris has been defined as coronary artery disease and severe angina, not available for further conventional pharmacological treatment or for revascularization procedures. The aim of the study was to assess fatality, morbidity and quality of life in patients with refractory angina.
  
  
  METHODS
  Patients with refractory angina were prospectively identified at seven centres and were compared with an age and gender matched group of patients accepted for revascularization due to severe angina.
  
  
  RESULTS
  Over three years, 139 patients with refractory angina were identified. The refractory group had more pronounced cardiac disease in terms of more previous myocardial infarctions (p < 0.05), more previous revascularization procedures (p < 0.0001), more severely impaired left ventricular ejection fraction (p < 0.001) as well as higher prevalence of renal dysfunction (p < 0.001) and insulin treated diabetes (p < 0.01) compared to the controls. The refractory patients had a higher one year fatality rate than the control group (10% vs. 0.7%; p < 0.001). Compared to the controls, the refractory group had significantly more impaired quality of life according to the Short Form 36 and the Seattle Angina Questionnaire with regard to physical function, physical well-being and impact of angina symptoms, but there were no differences with regard to mental health and emotional function.
  
  
  CONCLUSIONS
  Patients with refractory angina pectoris have severe angina symptoms, a more pronounced cardiac disease, a higher fatality rate and a markedly impaired quality of life compared with patients who undergo revascularization procedures due to symptomatic coronary artery disease. Additional symptomatic treatment modalities are highly warranted for this patient group.
authors.affiliation: Multidisciplinary Pain Center, Institute of Medicine, Sahlgrenska University Hospital/Östra, SE-416 85 Göteborg, Sweden. paulin.andrell@paincenter.se
authors.forename: Paulin
authors.initials: P
authors.lastname: Andréll
authors.forename: Olof
authors.initials: O
authors.lastname: Ekre
authors.forename: Lars
authors.initials: L
authors.lastname: Grip
authors.forename: Peter
authors.initials: P
authors.lastname: Währborg
authors.forename: Per
authors.initials: P
authors.lastname: Albertsson
authors.forename: Tore
authors.initials: T
authors.lastname: Eliasson
authors.forename: Anders
authors.initials: A
authors.lastname: Jeppsson
authors.forename: Clas
authors.initials: C
authors.lastname: Mannheimer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology* / Q000401:mortality* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D015996:Survival Rate / Q000639:trends