Effect of angina under-recognition on treatment in outpatients with stable ischaemic heart disease
Open accessAbstract
AIMS: Almost a third of outpatients with chronic coronary artery disease (CAD) report having angina in the prior month, which is frequently under-recognized by their cardiologists. Whether under-recognition is associated with less treatment escalation to control angina, and potential underuse of treatment, is unknown. METHODS AND RESULTS: Patients with CAD from 25 US cardiology outpatient practices completed the Seattle Angina Questionnaire (SAQ) prior to their clinic visit, and angina was categorized as daily, weekly, monthly and no angina. Cardiologists (n=155) independently quantified patients' angina, blinded to patients' SAQ scores. Under-recognition was defined as the physician reporting a lower category of angina frequency than the patient. Among 1257 patients with CAD, 411 reported angina in the past month, of whom 178 (43.3%) patients were under-recognized. Treatment escalation-defined as intensification (up-titration or addition) of antianginal medications, referral for diagnostic testing or revascularization, or hospital admission-occurred in 106 (25.8%) patients with angina. Patients with under-recognized angina were less likely to get treatment escalation than patients whose angina was appropriately recognized (8.4% vs 39.1%, P<0.001). In a hierarchical multivariable logistic regression model adjusting for demographic and clinical characteristics, as well as the burden of angina, under-recognition remained strongly associated with a lack of treatment escalation (adjusted OR 0.10, 95% CI 0.04-0.21, P<0.001). CONCLUSIONS: Under-recognition of angina in cardiology outpatient practices is associated with less aggressive treatment escalation and may lead to poorer angina control. Standardizing clinical recognition of angina using validated tools could reduce under-recognition of angina, facilitate treatment, and potentially improve outcomes.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Heart Disease and Stroke Statistics—2015 Update: A Report From the American Heart Association
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., de Ferranti, S., Després, J.-P., Fullerton, H. J., Howard, V. J., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000152 · Cited by 5,797 · see citing works
Fihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., Douglas, P. S., Foody, J. M., Gerber, T. C., Hinderliter, A. L., et al. (2012) · Circulation · doi:10.1161/cir.0b013e3182776f83 · Cited by 2,411 · see citing works
Self-citationFihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., Douglas, P. S., Foody, J. M., Gerber, T. C., Hinderliter, A. L., et al. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.07.013 · Cited by 1,560 · see citing works
Self-citationSpertus, J., Winder, J. A., Dewhurst, T. A., Deyo, R., Prodzinski, J., McDonnell, M., & Fihn, S. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(94)00397-9 · Cited by 1,413 · see citing works
Self-citationEffect of PCI on quality of life in patients with stable coronary disease.
Weintraub, W., Spertus, J., Kolm, P., Maron, D., Zhang, Z.-F., Jurkovitz, C., Zhang, W., Hartigan, P., Lewis, C., Veledar, E., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa072771 · Cited by 673 · see citing works
Self-citationPatel, M. R., DEHMER, G. J., Hirshfeld, J. W., Smith, P. K., & Spertus, J. A. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.12.001 · Cited by 595 · see citing works
Self-citationHealth Status Predicts Long-Term Outcome in Outpatients With Coronary Disease
Spertus, J., Jones, P. G., McDonell, M., Fan, V., & Fihn, S. (2002) · Circulation · doi:10.1161/01.cir.0000020688.24874.90 · Cited by 528 · see citing works
Self-citationArora, R. R., Chou, T. M., Jain, D., Fleishman, B. L., Crawford, L. E., McKiernan, T. L., & Nesto, R. W. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00140-0 · Cited by 492 · see citing works
Monitoring the quality of life in patients with coronary artery disease.
Spertus, J. A., Winder, J. A., Dewhurst, T. A., Deyo, R., & Fihn, S. D. (1994) · American Journal of Cardiology · doi:10.1016/0002-9149(94)90555-x · Cited by 435 · see citing works
Self-citationFrazier, O. H., MARCH, R. J., & Horvath, K. A. (1999) · New England Journal of Medicine · doi:10.1056/nejm199909303411402 · Cited by 378 · see citing works
Appropriateness of Percutaneous Coronary Intervention
Chan, P. S., Patel, M. R., Klein, L. W., Krone, R. J., DEHMER, G. J., Kennedy, K. F., Nallamothu, B. K., Weaver, W. D., Masoudi, F. A., Rumsfeld, J. S., et al. (2011) · JAMA · doi:10.1001/jama.2011.916 · Cited by 375 · see citing works
Self-citationBrindis, R. G., Douglas, P. S., Hendel, R. C., Peterson, E. D., Wolk, M. J., Allen, J. M., Patel, M. R., Raskin, I. E., Hendel, R. C., Bateman, T. M., et al. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.08.029 · Cited by 355 · see citing works
Self-citationMeta-analysis of Trials Comparing β-Blockers, Calcium Antagonists, and Nitrates for Stable Angina
Heidenreich, P. A. (1999) · JAMA · doi:10.1001/jama.281.20.1927 · Cited by 355 · see citing works
ACCF Proposed Method for Evaluating the Appropriateness of Cardiovascular Imaging
Patel, M. R., Spertus, J. A., Brindis, R. G., Hendel, R. C., Douglas, P. S., Peterson, E. D., Wolk, M. J., Allen, J. M., & Raskin, I. E. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.08.030 · Cited by 332 · see citing works
Self-citationBurkhoff, D., Schmidt, S. E., Schulman, S. P., MYERS, J. N., Resar, J. R., Becker, L. C., Weiss, J. L., & Jones, J. W. (1999) · The Lancet · doi:10.1016/s0140-6736(99)08113-1 · Cited by 311 · see citing works
Morrison, D. A., Sethi, G. K., Sacks, J. M., et al. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01366-3 · Cited by 305 · see citing works
Efficacy of a Device to Narrow the Coronary Sinus in Refractory Angina
Verheye, S., Jolicœur, E. M., Behan, M., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1402556 · Cited by 302 · see citing works
Development and Validation of a Short Version of the Seattle Angina Questionnaire
Chan, P. S., Jones, P. G., Arnold, S. A., & Spertus, J. (2014) · Circulation. Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.114.000967 · Cited by 287 · see citing works
Self-citationBrown, N., Melville, M., Gray, D., Young, T., Munro, J., Skene, A. M., & Hampton, J. R. (1999) · Heart · doi:10.1136/hrt.81.4.352 · Cited by 249 · see citing works
Abrams, J. (2005) · New England Journal of Medicine · doi:10.1056/nejmcp042317 · Cited by 244 · see citing works
Quantifying the Early Health Status Benefits of Successful Chronic Total Occlusion Recanalization
Grantham, J. A., Jones, P. G., Cannon, L., et al. (2010) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.108.825760 · Cited by 223 · see citing works
Predictors of Quality-of-Life Benefit After Percutaneous Coronary Intervention
Spertus, J. A., Salisbury, A. C., Jones, P. G., Conaway, D. G., & Thompson, R. C. (2004) · Circulation · doi:10.1161/01.cir.0000150392.70749.c7 · Cited by 189 · see citing works
Self-citationKernis, S. J., Harjai, K. J., Stone, G. W., Grines, L. L., Boura, J., O’Neill, W. W., & Grines, C. L. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.09.071 · Cited by 145 · see citing works
The Prevalence of Weekly Angina Among Patients With Chronic Stable Angina in Primary Care Practices
Beltrame, J. F. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.295 · Cited by 139 · see citing works
Self-citationBrorsson, B., Bernstein, S. J., Brook, R. H., & Werkö, L. (2002) · Heart · doi:10.1136/heart.87.2.140 · Cited by 136 · see citing works
Economic Impact of Angina After an Acute Coronary Syndrome: Insights From the MERLIN-TIMI 36 Trial
Arnold, S. V., Morrow, D. A., Lei, Y., Cohen, D. J., Mahoney, E. M., Braunwald, E., & Chan, P. S. (2009) · Circulation: Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.108.829523 · Cited by 128 · see citing works
Self-citationMeta-analysis: Effects of Percutaneous Coronary Intervention Versus Medical Therapy on Angina Relief
Wijeysundera, H. C., Nallamothu, B. K., Krumholz, H. M., Tu, J. V., & Ko, D. T. (2010) · Annals of Internal Medicine · doi:10.7326/0003-4819-152-6-201003160-00007 · Cited by 126 · see citing works
Soran, O. Z., Kennard, E. D., Kfoury, A. G., & Kelsey, S. F. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2005.07.122 · Cited by 124 · see citing works
McNab, D. C., Khan, S. N., Sharples, L. D., et al. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehi827 · Cited by 102 · see citing works
Comparison of the Seattle Angina Questionnaire With Daily Angina Diary in the TERISA Clinical Trial
Arnold, S. V., Kosiborod, M., Li, Y., Jones, P. G., Yue, P., Belardinelli, L., & Spertus, J. A. (2014) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.113.000752 · Cited by 97 · see citing works
Self-citationMeta-analysis: Effects of Percutaneous Coronary Intervention Versus Medical Therapy on Angina Relief
Gersh, B. J. (2011) · Yearbook of Cardiology · doi:10.1016/j.ycar.2011.01.112 · Cited by 94 · see citing works
Ko, D. T., Guo, H., Wijeysundera, H. C., Natarajan, M. K., Nagpal, D., Feindel, C. M., Kingsbury, K., Cohen, E. A., & Tu, J. V. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.06.056 · Cited by 91 · see citing works
Quality of life benefits of percutaneous coronary intervention for chronic occlusions
Safley, D. M., Grantham, J. A., Hatch, J. C., et al. (2013) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.25303 · Cited by 86 · see citing works
Aaberge, L., Rootwelt, K., Blomhoff, S., et al. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)01828-4 · Cited by 81 · see citing works
Bradley, S. M., Spertus, J. A., Kennedy, K. F., Nallamothu, B. K., Chan, P. S., Patel, M. R., Bryson, C. L., Malenka, D. J., & Rumsfeld, J. S. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.3904 · Cited by 81 · see citing works
Self-citationBenzer, W., Höfer, S., & Oldridge, N. (2003) · Herz · doi:10.1007/s00059-003-2388-9 · Cited by 77 · see citing works
Arnold, S. V., Grodzinsky, A., GOSCH, K. L., Kosiborod, M., Jones, P. G., Breeding, T., Towheed, A., Beltrame, J. F., Alexander, K. P., & Spertus, J. A. (2016) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.116.002781 · Cited by 64 · see citing works
Self-citationShafiq, A., Arnold, S. V., GOSCH, K. L., Kureshi, F., Breeding, T., Jones, P. G., Beltrame, J. F., & Spertus, J. A. (2016) · American Heart Journal · doi:10.1016/j.ahj.2016.02.015 · Cited by 60 · see citing works
Self-citationEffects of Ranolazine on Quality of Life Among Patients With Diabetes Mellitus and Stable Angina
Arnold, S. V., Kosiborod, M., McGuire, D. K., Li, Y., Yue, P., Ben‐Yehuda, O., & Spertus, J. A. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.2120 · Cited by 21 · see citing works
Self-citationShafiq, A., Kureshi, F., Arnold, S. V., GOSCH, K. L., Breeding, T., Jones, P. G., & Spertus, J. A. (2015) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.8.suppl_2.7 · Cited by 2 · see citing works
Self-citationGrodzinsky, A., Kosiborod, M., Beltrame, J. F., et al. (2015) · Circulation · doi:10.1161/circ.132.suppl_3.18360 · Cited by 1 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001168 · Cited by 1,598 · see citing works
Self-citationInterpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care
Spertus, J. A., Jones, P. G., Sandhu, A. T., & Arnold, S. V. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.09.542 · Cited by 619 · see citing works
Self-citationVirani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.04.003 · Cited by 596 · see citing works
Self-citationArnold, S. V., Bhatt, D. L., Barsness, G. W., Beatty, A. L., Deedwania, P. C., Inzucchi, S. E., Kosiborod, M., Leiter, L. A., Lipska, K. J., Newman, J. D., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000766 · Cited by 304 · see citing works
Self-citation
- Authors
- Qintar, M., Spertus, J. A., Gosch, K. L., Beltrame, J., Kureshi, F., Shafiq, A., Breeding, T., Alexander, K. P., & Arnold, S. V.
- Affiliations
- Saint Luke's Hospital (US)
- The University of Adelaide (AU)
- Duke Medical Center (US)
- Corresponding author
- Qintar, Mohammed
- ORCID
- Venue
- European Heart Journal - Quality of Care and Clinical Outcomes
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-03-25
- Volume
- 2
- Issue
- 3
- Pages
- 208-214
- ISSN
- 2058-1742 (ISSN-L)
- 2058-5225
- PMC
- PMC5322471
- OpenAlex
- W2316929311
- Cited by
- 44
- References
- 41
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 3 · 2020: 6 · 2019: 7 · 2018: 7 · 2017: 3
- FWCI
- 6.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal - Quality of Care and Clinical Outcomes (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Gilead Sciences
- National Heart, Lung, and Blood Institute
- National Institutes of Health (T32HL110837)
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- stable ischaemic heart disease, stable coronary artery disease, angina frequency, treatment escalation, patient-physician agreement, Seattle Angina Questionnaire, outpatients, revascularization, diagnostic testing
- MeSH terms
- Cardiologists, Aged, Aged, 80 and over, Angina Pectoris, Cardiovascular Agents, Clinical Competence, Coronary Artery Disease, Cross-Sectional Studies, Female, Health Status, Humans, Male, Middle Aged, Outpatients, Practice Patterns, Physicians', United States, Prevalence, Myocardial Ischemia, Quality Indicators, Health Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
