The Burden of Chronic Angina

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US Cardiology 2004;2004:1(1):1-4

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Chronic angina is traditionally recognized as the cardinal symptom or manifestion of coronary artery disease (CAD), and worsening angina symptoms signal progression of the underlying pathology.1 Whereas the value of monitoring angina frequency and severity as a metric to identify disease progression is widely accepted, this long-held tradition may have paradoxically obscured the tremendous impact chronic angina pain or discomfort imposes on the daily lives of patients with CAD.

According to the American College of Cardiology/American Heart Association (ACC/AHA) 2002 Guideline Update for the Management of Patients with Chronic Stable Angina, the goals of chronic angina management are two-fold: to reduce morbidity and mortality; and to reduce symptoms. The reduction of symptoms should include complete or nearly complete elimination of angina chest pain or discomfort and a return to normal activities.1 The authors note that it is the reduction of symptoms that is of greater concern when viewed from the perspective of patients with angina. Essentially, patients should return to as normal a life as possible, given their individual circumstances.2

Unfortunately, a significant number of Americans continue to suffer from chronic angina attacks despite medical advances. Because of the intermittent and sometimes unpredictable pattern of chronic angina, patients must often downscale their lives to avoid attacks, which in turn may lead to reduced productivity in the workplace, increased bouts of depression, increased medical costs, and higher out-of-pocket expenses. These, in turn, may increase levels of patient anxiety and lead to angina attacks of greater frequency and severity - essentially sending patients into a downward spiral of worsening angina symptoms and decrements in physical and social functioning despite interventions. Ultimately, patients may have unacceptable quality of life during an era in which medical advances have increased the quantity of their lives.

The AHA reports that 6.8 million patients in the US suffer from angina, and approximately 400,000 new cases of angina are reported annually.3 According to the US Census Bureau, 59.6 million people in the US were 55 years of age or older in March 2002.4 Therefore, based on the estimated prevalence of chronic angina, approximately 9.0% of the group that is 55 years of age or older may be suffering from debilitating chronic angina attacks.

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References
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