Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography:: a randomised controlled trial

Michelle C. Williams; Amanda Hunter; Anoop Shah; Valentina Assi; Stephanie Lewis; Kenneth Mangion; Colin Berry; Nicholas A. Boon; Elizabeth  Clark; Marcus Flather; John Forbes; Scott McLean; Giles Roditi; Edwin J. R. van Beek; Adam D. Timmis; David E. Newby

doi:10.1136/heartjnl-2016-310129

Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography: a randomised controlled trial

Michelle C. Williams
, Amanda Hunter
, Anoop Shah
, Valentina Assi
, Stephanie Lewis
, Kenneth Mangion
, Colin Berry
, Nicholas A. Boon
, Elizabeth Clark
, Marcus Flather
, John Forbes
, Scott McLean
, Giles Roditi
, Edwin J. R. van Beek
, Adam D. Timmis
, David E. Newby (Lead / Corresponding author)
,

Research output: Contribution to journal › Article › peer-review

39 Citations (Scopus)

329 Downloads (Pure)

Abstract

Background: In patients with suspected angina pectoris, CT coronary angiography (CTCA) clarifies the diagnosis, directs appropriate investigations and therapies, and reduces clinical events. The effect on patient symptoms is currently unknown.

Methods: In a prospective open-label parallel group multicentre randomised controlled trial, 4146 patients with suspected angina due to coronary heart disease were randomised 1:1 to receive standard care or standard care plus CTCA. Symptoms and quality of life were assessed over 6 months using the Seattle Angina Questionnaire and Short Form 12.

Results: Baseline scores indicated mild physical limitation (74±0.4), moderate angina stability (44±0.4), modest angina frequency (68±0.4), excellent treatment satisfaction (92±0.2) and moderate impairment of quality of life (55±0.3). Compared with standard care alone, CTCA was associated with less marked improvements in physical limitation (difference −1.74 (95% CIs, −3.34 to −0.14), p=0.0329), angina frequency (difference −1.55 (−2.85 to −0.25), p=0.0198) and quality of life (difference −3.48 (−4.95 to −2.01), p<0.0001) at 6 months. For patients undergoing CTCA, improvements in symptoms were greatest in those diagnosed with normal coronary arteries or who had their preventative therapy discontinued, and least in those with moderate non-obstructive disease or had a new prescription of preventative therapy (p<0.001 for all).

Conclusions: While improving diagnosis, treatment and outcome, CTCA is associated with a small attenuation of the improvements in symptoms and quality of life due to the detection of moderate non-obstructive coronary artery disease.

Original language	English
Pages (from-to)	995-1001
Number of pages	7
Journal	Heart (British Cardiac Society)
Volume	103
Issue number	13
Early online date	28 Feb 2017
DOIs	https://doi.org/10.1136/heartjnl-2016-310129
Publication status	Published - Jul 2017

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Williams, M. C., Hunter, A., Shah, A., Assi, V., Lewis, S., Mangion, K., Berry, C., Boon, N. A., Clark, E., Flather, M., Forbes, J., McLean, S., Roditi, G., van Beek, E. J. R., Timmis, A. D., Newby, D. E. (2017). Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography: a randomised controlled trial . Heart (British Cardiac Society), 103(13), 995-1001. https://doi.org/10.1136/heartjnl-2016-310129

@article{a772f45975564c29ac1d3323783793ff,

title = "Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography:: a randomised controlled trial ",

abstract = "Background: In patients with suspected angina pectoris, CT coronary angiography (CTCA) clarifies the diagnosis, directs appropriate investigations and therapies, and reduces clinical events. The effect on patient symptoms is currently unknown. Methods: In a prospective open-label parallel group multicentre randomised controlled trial, 4146 patients with suspected angina due to coronary heart disease were randomised 1:1 to receive standard care or standard care plus CTCA. Symptoms and quality of life were assessed over 6 months using the Seattle Angina Questionnaire and Short Form 12. Results: Baseline scores indicated mild physical limitation (74±0.4), moderate angina stability (44±0.4), modest angina frequency (68±0.4), excellent treatment satisfaction (92±0.2) and moderate impairment of quality of life (55±0.3). Compared with standard care alone, CTCA was associated with less marked improvements in physical limitation (difference −1.74 (95\% CIs, −3.34 to −0.14), p=0.0329), angina frequency (difference −1.55 (−2.85 to −0.25), p=0.0198) and quality of life (difference −3.48 (−4.95 to −2.01), p<0.0001) at 6 months. For patients undergoing CTCA, improvements in symptoms were greatest in those diagnosed with normal coronary arteries or who had their preventative therapy discontinued, and least in those with moderate non-obstructive disease or had a new prescription of preventative therapy (p<0.001 for all). Conclusions: While improving diagnosis, treatment and outcome, CTCA is associated with a small attenuation of the improvements in symptoms and quality of life due to the detection of moderate non-obstructive coronary artery disease.",

author = "Williams, \{Michelle C.\} and Amanda Hunter and Anoop Shah and Valentina Assi and Stephanie Lewis and Kenneth Mangion and Colin Berry and Boon, \{Nicholas A.\} and Elizabeth Clark and Marcus Flather and John Forbes and Scott McLean and Giles Roditi and \{van Beek\}, \{Edwin J. R.\} and Timmis, \{Adam D.\} and Newby, \{David E.\} and Graeme Houston",

note = "This trial was funded by The Chief Scientist Office of the Scottish Government Health and Social Care Directorates (CZH/4/588), with supplementary awards from Edinburgh and Lothian{\textquoteright}s Health Foundation Trust and the Heart Diseases Research Fund. ",

year = "2017",

month = jul,

doi = "10.1136/heartjnl-2016-310129",

language = "English",

volume = "103",

pages = "995--1001",

journal = "Heart (British Cardiac Society)",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "13",

}

Williams, MC, Hunter, A, Shah, A, Assi, V, Lewis, S, Mangion, K, Berry, C, Boon, NA, Clark, E, Flather, M, Forbes, J, McLean, S, Roditi, G, van Beek, EJR, Timmis, AD, Newby, DE 2017, 'Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography: a randomised controlled trial ', Heart (British Cardiac Society), vol. 103, no. 13, pp. 995-1001. https://doi.org/10.1136/heartjnl-2016-310129

TY - JOUR

T1 - Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography:

T2 - a randomised controlled trial

AU - Williams, Michelle C.

AU - Hunter, Amanda

AU - Shah, Anoop

AU - Assi, Valentina

AU - Lewis, Stephanie

AU - Mangion, Kenneth

AU - Berry, Colin

AU - Boon, Nicholas A.

AU - Clark, Elizabeth

AU - Flather, Marcus

AU - Forbes, John

AU - McLean, Scott

AU - Roditi, Giles

AU - van Beek, Edwin J. R.

AU - Timmis, Adam D.

AU - Newby, David E.

AU - Houston, Graeme

N1 - This trial was funded by The Chief Scientist Office of the Scottish Government Health and Social Care Directorates (CZH/4/588), with supplementary awards from Edinburgh and Lothian’s Health Foundation Trust and the Heart Diseases Research Fund.

PY - 2017/7

Y1 - 2017/7

N2 - Background: In patients with suspected angina pectoris, CT coronary angiography (CTCA) clarifies the diagnosis, directs appropriate investigations and therapies, and reduces clinical events. The effect on patient symptoms is currently unknown. Methods: In a prospective open-label parallel group multicentre randomised controlled trial, 4146 patients with suspected angina due to coronary heart disease were randomised 1:1 to receive standard care or standard care plus CTCA. Symptoms and quality of life were assessed over 6 months using the Seattle Angina Questionnaire and Short Form 12. Results: Baseline scores indicated mild physical limitation (74±0.4), moderate angina stability (44±0.4), modest angina frequency (68±0.4), excellent treatment satisfaction (92±0.2) and moderate impairment of quality of life (55±0.3). Compared with standard care alone, CTCA was associated with less marked improvements in physical limitation (difference −1.74 (95% CIs, −3.34 to −0.14), p=0.0329), angina frequency (difference −1.55 (−2.85 to −0.25), p=0.0198) and quality of life (difference −3.48 (−4.95 to −2.01), p<0.0001) at 6 months. For patients undergoing CTCA, improvements in symptoms were greatest in those diagnosed with normal coronary arteries or who had their preventative therapy discontinued, and least in those with moderate non-obstructive disease or had a new prescription of preventative therapy (p<0.001 for all). Conclusions: While improving diagnosis, treatment and outcome, CTCA is associated with a small attenuation of the improvements in symptoms and quality of life due to the detection of moderate non-obstructive coronary artery disease.

AB - Background: In patients with suspected angina pectoris, CT coronary angiography (CTCA) clarifies the diagnosis, directs appropriate investigations and therapies, and reduces clinical events. The effect on patient symptoms is currently unknown. Methods: In a prospective open-label parallel group multicentre randomised controlled trial, 4146 patients with suspected angina due to coronary heart disease were randomised 1:1 to receive standard care or standard care plus CTCA. Symptoms and quality of life were assessed over 6 months using the Seattle Angina Questionnaire and Short Form 12. Results: Baseline scores indicated mild physical limitation (74±0.4), moderate angina stability (44±0.4), modest angina frequency (68±0.4), excellent treatment satisfaction (92±0.2) and moderate impairment of quality of life (55±0.3). Compared with standard care alone, CTCA was associated with less marked improvements in physical limitation (difference −1.74 (95% CIs, −3.34 to −0.14), p=0.0329), angina frequency (difference −1.55 (−2.85 to −0.25), p=0.0198) and quality of life (difference −3.48 (−4.95 to −2.01), p<0.0001) at 6 months. For patients undergoing CTCA, improvements in symptoms were greatest in those diagnosed with normal coronary arteries or who had their preventative therapy discontinued, and least in those with moderate non-obstructive disease or had a new prescription of preventative therapy (p<0.001 for all). Conclusions: While improving diagnosis, treatment and outcome, CTCA is associated with a small attenuation of the improvements in symptoms and quality of life due to the detection of moderate non-obstructive coronary artery disease.

U2 - 10.1136/heartjnl-2016-310129

DO - 10.1136/heartjnl-2016-310129

M3 - Article

C2 - 28246175

SN - 1355-6037

VL - 103

SP - 995

EP - 1001

JO - Heart (British Cardiac Society)

JF - Heart (British Cardiac Society)

IS - 13

ER -

Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography: a randomised controlled trial

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