Outcomes/Effectiveness Research

Patients with unstable angina do not have better 1-year health status or rehospitalization outcomes than heart attack patients, despite better 2-year survival

Patients with unstable angina (UA) have better survival rates 2 years after hospitalization for heart problems than heart attack patients. However, they have similar or worse health status and cardiac rehospitalization rates 1 year after their initial hospitalization for acute coronary syndrome (ACS), concludes a new study. ACS includes ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). STEMI and NSTEMI are types of heart attacks, whereas UA represents chest pain that may be a precursor to a heart attack.

A research team evaluated the associations between ACS presentation (UA, STEMI, and NSTEMI) and 1-year health status, 1-year cardiac rehospitalization rates, and 2-year mortality outcomes, among a group of 1,192 ACS survivors from 2 Kansas City hospitals. After adjustment for patient demographic, hospital, treatment, and other factors, UA patients were 42 percent more likely to experience angina at 1 year than STEMI patients and equally likely to experience angina as NSTEMI patients. In addition, UA patients fared no better than heart attack patients in physical functioning or quality of life. Finally, UA patients had similar rehospitalization rates as heart attack patients 1 year after hospitalization for ACS, despite better 2-year survival rates.

Thus, clinicians should remain as vigilant for persistent angina, functional limitations, and poor quality of life among UA patients as they are among heart attack patients, suggest the researchers. Multiple treatments, including medications and coronary revascularization, are available to improve patients' angina. The study was funded by the Agency for Healthcare Research and Quality (HS11282).

See "One-year health status outcomes of unstable angina versus myocardial infarction: A prospective, observational cohort study of ACS survivors," by Thomas M. Maddox, M.D., Kimberly J. Reid, M.S., John S. Rumsfeld, M.D., Ph.D., and John A. Spertus, M.D., M.P.H., in BMC Cardiovascular Disorders 7(28), 2007.

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