title: Assessing Quality of Life and Medical Care in Chronic Angina: An Internet Survey.
abstract: BACKGROUND
  Angina is a clinical syndrome whose recognition relies heavily on self-report, so its identification can be challenging. Most data come from cohorts identified by physicians and nurses at the point of care; however, current widespread access to the Internet makes identification of community cohorts feasible and offers a complementary picture of angina.
  
  
  OBJECTIVE
  To describe a population self-identified as experiencing chronic angina by use of an Internet survey.
  
  
  METHODS
  Using email and an Internet portal, we invited individuals with a diagnosis of angina and recent symptoms to complete an Internet survey on treatment and quality of life (QOL). In total, 1147 surveys were received. The main analysis was further limited to those reporting a definite coronary heart disease (CHD) history (N=646, 56% of overall).
  
  
  RESULTS
  Overall, about 15% reported daily angina and 40% weekly angina. Those with more frequent angina were younger, more often depressed, and reported a shorter time since diagnosis. They also had substantially worse treatment satisfaction, physical function, and overall QOL. Fewer than 40% were on ≥ 2 anti-anginals, even with daily angina. The subjects without a history of definite CHD had unexpectedly low use of antianginal and evidence-based medicines, suggesting either a lack of specificity in the use of self-reported angina to identify patients with CHD or lack of access to care.
  
  
  CONCLUSIONS
  Use of inexpensive electronic tools can identify community-based angina cohorts for clinical research. Limitation to subjects with a definite history of CHD lends diagnostic face validity to the approach; however, other symptomatic individuals are also identified.
authors.affiliation: Duke University Medical Center, Department of Cardiology, Durham, NC, United States. karen.alexander@duke.edu.
authors.forename: Karen P
authors.identifier: http://orcid.org/0000-0003-4418-1424
authors.initials: KP
authors.lastname: Alexander
authors.forename: Olena
authors.identifier: http://orcid.org/0000-0002-0878-6234
authors.initials: O
authors.lastname: Stadnyuk
authors.forename: Suzanne V
authors.identifier: http://orcid.org/0000-0003-3367-0302
authors.initials: SV
authors.lastname: Arnold
authors.forename: Daniel B
authors.identifier: http://orcid.org/0000-0001-6340-8087
authors.initials: DB
authors.lastname: Mark
authors.forename: E Magnus
authors.identifier: http://orcid.org/0000-0002-6249-4988
authors.initials: EM
authors.lastname: Ohman
authors.forename: Kevin J
authors.identifier: http://orcid.org/0000-0001-6452-2172
authors.initials: KJ
authors.lastname: Anstrom
keywords: Angina; Internet; Quality of Life; Surveys and Questionnaires