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Economic Impact of Angina After an Acute Coronary Syndrome: Insights From the MERLIN-TIMI 36 Trial
Abstract
Background— Angina in patients with coronary artery disease is associated with worse quality of life; however, the relationship between angina frequency and resource utilization is unknown. Methods and Results— Using data from the MERLIN-TIMI 36 trial, we assessed the association between the extent of angina after an acute coronary syndrome (ACS) and subsequent cardiovascular resource utilization among 5460 stable outpatients who completed the Seattle Angina Questionnaire at 4 months after an ACS and who were then followed for an additional 8 months. Angina frequency was categorized as none (score, 100; 2739 patients), monthly (score, 61 to 99; 1608 patients), weekly (score, 31 to 60; 854 patients), and daily (score, 0 to 30; 259 patients). Multivariable regression models evaluated the association between angina frequency and overall costs attributable to cardiovascular hospitalizations, outpatient visits and procedures, and medications. As compared with no angina, overall costs increased in a graded fashion with higher angina frequency—no angina, $2928 (reference); monthly angina, $3909 (adjusted relative cost ratio, 1.29; 95% CI, 1.21 to 1.39); weekly angina, $4558 (adjusted relative cost ratio, 1.52; 95% CI, 1.48 to 1.67); and daily angina, $6949 (adjusted relative cost ratio, 2.32; 95% CI, 2.01 to 2.69; P for trend <0.001). Differences in costs were attributable primarily to higher rates of ACS hospitalization and coronary revascularization among patients with more severe angina. Conclusion— Among stable outpatients after ACS, a direct graded relationship was found between higher angina frequency and healthcare costs. As compared with patients without angina, patients with daily angina had a >2-fold increase in resource utilization and incremental costs of $4000 after 8 months of follow-up.
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Self-citation
Metadata
- Authors
- Arnold, S. V., Morrow, D. A., Lei, Y., Cohen, D. J., Mahoney, E. M., Braunwald, E., & Chan, P. S.
- Affiliations
- Brigham and Women's Hospital (US)
- From the Saint Luke’s Mid America Heart Institute (S.V.A., Y.L., D.J.C., E.M.M., P.S.C.), Kansas City, Mo; and the TIMI Study Group (D.A.M., E.B.), Brigham and Women’s Hospital, Boston, Mass.
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2009-07
- Volume
- 2
- Issue
- 4
- Pages
- 344-353
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- OpenAlex
- W2887283102
- Cited by
- 128
- References
- 32
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 6 · 2023: 7 · 2022: 4 · 2021: 17 · 2020: 6 · 2019: 7 · 2018: 9 · 2017: 10 · 2016: 7 · 2015: 19 · 2014: 9 · 2013: 6 · 2012: 7
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- Max Planck Institute for Plasma Physics (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- angina frequency, acute coronary syndrome, health care costs, resource utilization (health care), coronary artery disease, Seattle Angina Questionnaire, hospitalization, coronary revascularization, stable outpatients
- MeSH terms
- Ranolazine, Acetanilides, Aged, Ambulatory Care, Angina Pectoris, Costs and Cost Analysis, Enzyme Inhibitors, Female, Follow-Up Studies, Health Status, Hospitalization, Humans, Male, Middle Aged, Piperazines, Quality of Life, Surveys and Questionnaires, Health Care Costs, Kaplan-Meier Estimate, Acute Coronary Syndrome
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