Objectives: Refractory angina patients suffer debilitating chest pain despite optimal medical therapy and previous cardiovascular intervention. Cardiac rehabilitation is often not prescribed due to a lack of evidence regarding potential efficacy and patient suitability. A randomised controlled study was undertaken to explore the impact of cardiac rehabilitation on cardiovascular risk factors, physical ability, quality of life and psychological morbidity among refractory angina sufferers. Methods: Forty-two refractory angina patients (65.1 ± 7.3 years) were randomly assigned to an 8-week Phase III cardiac rehabilitation program or symptom diary control. Physical assessment, Progressive Shuttle Walk test, Hospital Anxiety and Depression Scale, Health Anxiety Questionnaire, the York Angina Beliefs scale, ENRICHD Social Support Instrument and SF-36 were completed before and after intervention and at 8-week follow-up. Results: Following cardiac rehabilitation, patients demonstrated improved physical ability compared with controls in Progressive Shuttle Walk level attainment (p = 0.005) and total distance covered (p = 0.015). Angina frequency and severity remained unchanged in both groups, with the control demonstrating worsening SF-36 pain scale (63.43 ± 22.28 vs. 55.46 ± 23.98, p = 0.025). Cardiac rehabilitation participants showed improved Health Anxiety Questionnaire reassurance (1.71 ± 1.72 vs. 1.14 ± 1.23, p = 0.026) and York Beliefs anginal threat perception (12.42 ± 4.58 vs. 14.35 ± 4.73, p = 0.05) after cardiac rehabilitation. Physical measures were broadly unaffected. Conclusions: Cardiac rehabilitation can be prescribed to improve physical ability without affecting angina frequency or severity among patients with refractory angina.

Journal Section:
Editor's choice
Keywords:
Refractory angina, Cardiac rehabilitation, Psychological morbidity, Quality of life
1.
Mannheimer C, Camici P, Chester MR, et al: The problem of chronic refractory angina; report from the ESC Joint Study Group on the Treatment of Refractory Angina. Eur Heart J 2002;23:355–370.
[PubMed]
https://doi.org/10.1053%2Feuhj.2001.2706
2.
DeJongste MJ, Tio RA, Foreman RD: Chronic therapeutically refractory angina pectoris. Heart 2004;90:225–230.
https://doi.org/10.1136%2Fhrt.2003.025031
3.
Gowda RM, Khan IA, Punukollu G, Vasavada BC, Nair CK: Treatment of refractory angina pectoris. Int J Cardiol 2005;101:1–7.
https://doi.org/10.1016%2Fj.ijcard.2004.03.066
4.
Chester M, Hammond C, Leach A: Long-term benefits of stellate ganglion block in severe chronic refractory angina. Pain 2000;87:103–105.
https://doi.org/10.1016%2FS0304-3959%2800%2900270-0
5.
Borjesson M: Visceral chest pain in unstable angina pectoris and effects of transcutaneous electrical nerve stimulation (TENS). A review. Herz 1999;24:114–125.
https://doi.org/10.1007%2FBF03043850
6.
Andrell P, Yu W, Gersbach P, et al: Long-term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris – results from the European Angina Registry Link Study (EARL). Heart 2010;96:1132–1136.
https://doi.org/10.1136%2Fhrt.2009.177188
7.
Taylor RS, De VJ, Buchser E, DeJongste MJ: Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials. BMC Cardiovasc Disord 2009;9:13.
https://doi.org/10.1186%2F1471-2261-9-13
8.
Fitzgerald CP, Lawson WE, Hui JC, Kennard ED: Enhanced external counterpulsation as initial revascularization treatment for angina refractory to medical therapy. Cardiology 2003;100:129–135.
[PubMed]
https://doi.org/10.1159%2F000073930
9.
McNab D, Khan SN, Sharples LD, et al: An open label, single-centre, randomized trial of spinal cord stimulation vs. percutaneous myocardial laser revascularization in patients with refractory angina pectoris: the SPiRiT trial. Eur Heart J 2006;27:1048–1053.
https://doi.org/10.1093%2Feurheartj%2Fehi827
10.
Moore RK, Groves D, Bateson S, et al: Health related quality of life of patients with refractory angina before and one year after enrolment onto a refractory angina program. Eur J Pain 2005;9:305–310.
https://doi.org/10.1016%2Fj.ejpain.2004.07.013
11.
Cossette S, Frasure-Smith N, Lesperance F: Clinical implications of a reduction in psychological distress on cardiac prognosis in patients participating in a psychosocial intervention program. Psychosom Med 2001;63:257–266.
12.
Johnston M, Foulkes J, Johnston DW, Pollard B, Gudmundsdottir H: Impact on patients and partners of inpatient and extended cardiac counseling and rehabilitation: a controlled trial. Psychosom Med 1999;61:225–233.
[PubMed]
13.
Yoshida T, Kohzuki M, Yoshida K, et al: Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction. Nurs Health Sci 1999;1:163–170.
https://doi.org/10.1046%2Fj.1442-2018.1999.00021.x
14.
Marchionni N, Fattirolli F, Fumagalli S, et al: Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial. Circulation 2003;107:2201–2206.
[PubMed]
https://doi.org/10.1161%2F01.CIR.0000066322.21016.4A
15.
Rafanelli C, Roncuzzi R, Finos L, et al: Psychological assessment in cardiac rehabilitation. Psychother Psychosom 2003;72:343–349.
[PubMed]
https://doi.org/10.1159%2F000073031
16.
Moore R, Groves D, Hammond C, Leach A, Chester MR: Temporary sympathectomy in the treatment of chronic refractory angina. J Pain Symptom Manage 2005;30:183–191.
https://doi.org/10.1016%2Fj.jpainsymman.2005.02.016
17.
Fletcher GF, Balady GJ, Amsterdam EA, et al: Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 2001;104:1694–1740.
[PubMed]
https://doi.org/10.1161%2Fhc3901.095960
18.
Taylor RS, Brown A, Ebrahim S, et al: Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116:682–692.
[PubMed]
https://doi.org/10.1016%2Fj.amjmed.2004.01.009
19.
Lewin RJ: Improving quality of life in patients with angina. Heart 1999;82:654–655.
20.
Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE: Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992;47:1019–1024.
[PubMed]
https://doi.org/10.1136%2Fthx.47.12.1019
21.
Lucock MP, Morley S: The Health Anxiety Questionnaire. Br J Health Psychol 1996;1:137–150.
https://doi.org/10.1111%2Fj.2044-8287.1996.tb00498.x
22.
Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–370.
[PubMed]
https://doi.org/10.1111%2Fj.1600-0447.1983.tb09716.x
23.
Stewart AL, Hays RD, Ware JE Jr: The MOS short-form general health survey. Reliability and validity in a patient population. Med Care 1988;26:724–735.
[PubMed]
https://doi.org/10.1097%2F00005650-198807000-00007
24.
Furze G, Bull P, Lewin RJ, Thompson DR: Development of the York Angina Beliefs Questionnaire. J Health Psychol 2003;8:307–315.
https://doi.org/10.1177%2F13591053030083002
25.
Enhancing recovery in coronary heart disease patients (ENRICHD): study design and methods. The ENRICHD investigators. Am Heart J 2000;139:1–9.
[PubMed]
26.
British Association for Cardiac Rehabilitation. Standards and Core Components for Cardiac Rehabilitation. London, British Association for Cardiac Rehabilitation, 2007.
27.
Asbury EA, Creed F, Collins P: Distinct psychosocial differences between women with coronary heart disease and cardiac syndrome X. Eur Heart J 2004;25:1695–1701.
https://doi.org/10.1016%2Fj.ehj.2004.07.035
28.
Altman D: Practical Statistics for Medical Research. London, Chapman and Hall, 1991.
29.
Wenger NK: Current status of cardiac rehabilitation. J Am Coll Cardiol 2008;51:1619–1631.
https://doi.org/10.1016%2Fj.jacc.2008.01.030
30.
Davies P, Taylor F, Beswick A, et al: Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database Syst Rev 2010;CD007131.
31.
Bethell H, Lewin R, Dalal H: Cardiac rehabilitation in the United Kingdom. Heart 2009;95:271–275.
https://doi.org/10.1136%2Fhrt.2007.134338
32.
Asbury EA, Slattery C, Grant A, Evans L, Barbir M, Collins P: Cardiac rehabilitation for the treatment of women with chest pain and normal coronary arteries. Menopause 2008;15:454–460.
https://doi.org/10.1097%2Fgme.0b013e31815982eb
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