title: Management of patients with refractory angina: Canadian Cardiovascular Society/Canadian Pain Society joint guidelines.
abstract: Refractory angina (RFA) is a debilitating disease characterized by cardiac pain resistant to conventional treatments for coronary artery disease including nitrates, calcium-channel and β-adrenoceptor blockade, vasculoprotective agents, percutaneous coronary interventions, and coronary artery bypass grafting. The mortality rate of patients living with RFA is not known but is thought to be in the range of approximately 3%. These individuals suffer severely impaired health-related quality of life with recurrent and sustained pain, poor general health status, psychological distress, impaired role functioning, and activity restriction. Effective care for RFA sufferers in Canada is critically underdeveloped. These guidelines are predicated upon a 2009 Canadian Cardiovascular Society (CCS) Position Statement which identified that underlying the problem of RFA management is the lack of a formalized, coordinated, interprofessional strategy between the cardiovascular and pain science/clinical communities. The guidelines are therefore a joint initiative of the CCS and the Canadian Pain Society (CPS) and make practice recommendations about treatment options for RFA that are based on the best available evidence. Concluding summary recommendations are also made, giving direction to future clinical practice and research on RFA management in Canada.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada. michael.mcgillion@utoronto.ca
authors.forename: Michael
authors.initials: M
authors.lastname: McGillion
authors.forename: Heather M
authors.initials: HM
authors.lastname: Arthur
authors.forename: Allison
authors.initials: A
authors.lastname: Cook
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Carroll
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Philippe L
authors.initials: PL
authors.lastname: L'allier
authors.forename: E Marc
authors.initials: EM
authors.lastname: Jolicoeur
authors.forename: Nelson
authors.initials: N
authors.lastname: Svorkdal
authors.forename: Joel
authors.initials: J
authors.lastname: Niznick
authors.forename: Kevin
authors.initials: K
authors.lastname: Teoh
authors.forename: Tammy
authors.initials: T
authors.lastname: Cosman
authors.forename: Barry
authors.initials: B
authors.lastname: Sessle
authors.forename: Judy
authors.initials: J
authors.lastname: Watt-Watson
authors.forename: Alexander
authors.initials: A
authors.lastname: Clark
authors.forename: Paul
authors.initials: P
authors.lastname: Taenzer
authors.forename: Peter
authors.initials: P
authors.lastname: Coyte
authors.forename: Louise
authors.initials: L
authors.lastname: Malysh
authors.forename: Carol
authors.initials: C
authors.lastname: Galte
authors.forename: James
authors.initials: J
authors.lastname: Stone
mesh_terms: D000203:Activities of Daily Living; D000787:Angina Pectoris / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002170:Canada; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D019468:Disease Management; D006801:Humans; D015201:Meta-Analysis as Topic; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D010148:Intractable Pain / Q000150:complications / Q000503:physiopathology; D010348:Patient Care Team / Q000458:organization & administration; D019984:Quality Indicators, Health Care; D017751:Safety Management / Q000592:standards; D055502:Secondary Prevention; D012648:Self Care / Q000379:methods*; D018434:Sickness Impact Profile; D012955:Societies, Medical; D013315:Stress, Psychological / Q000209:etiology
chemical_list: D002317:Cardiovascular Agents