Session number: 1013
Abstract title: Outpatient management of chronic stable angina in the VA: Data from the ACQUIP study
Author(s):
ML Burman - VA Puget Sound Health Care System, HSR&D and University of Washington, Department of Medicine
MB McDonell - VA Puget Sound Health Care System, HSR&D
SD Fihn - VA Puget Sound Health Care System, HSR&D and University of Washington, Department of Medicine
Objectives: We examined the pattern and success of treatment for chronic stable angina in outpatients with self-reported ischemic heart disease at the Seattle VA.
Methods: We performed a cross-sectional analysis of data from the Ambulatory Care Quality Improvement Project (ACQUIP) for patients followed in the Seattle General Internal Medicine Clinic (GIMC) . ACQUIP survey information included demographics and an inventory of active medical conditions. Patients reporting angina, coronary artery disease, heart attack, coronary artery bypass grafting (CABG), or balloon angioplasty (PTCA) were sent the Seattle Angina Questionnaire (SAQ) which includes measures of symptom severity and symptom burden. We used VistA to ascertain active prescriptions for anti-anginal medications (beta-blockers, calcium channel blockers, long-acting nitrates) in the 90 days before and after return of the SAQ. Administrative databases were used to ascertain contra-indications to each anti-anginal medication and clinical utilization. Successful management was defined as control of anginal symptoms or consideration of revascularization in patients whose anginal symptoms were refractory to medical management.
Results: 2,552 of the 6,995 patients who were enrolled in the Seattle GIMC at the beginning of the study were eligible to receive the SAQ based on self-report. Of 1,859 (73%) who returned at least one SAQ, 48% reported prior myocardial infarction (MI) and 47% reported prior revascularization (CABG and/or PTCA). 710 (40%) reported angina weekly or more often and 856 (53%) reported moderate to severe limitation in activities of daily living due to angina. Of the 1364 (75%) without contraindications to antianginal medications, 56% were on none. Of the 574 who reported a prior MI and no contraindications, only 37% were receiving a beta-blocker.
Conclusions: A majority of patients with self-reported chronic stable angina appeared to have inadequately controlled symptoms and a large number were receiving no anti-anginal medications.
Impact statement: Although processes and outcomes of care for acute coronary syndrome in the VA have improved dramatically over the past several years, this study suggests improvements are necessary in outpatient management of chronic stable angina.