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European Heart Journal 1996 17(Supplement A):29-40; doi:10.1093/eurheartj/17.suppl_A.29
Copyright © 1996 by the European Society of Cardiology.
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© 1996 1996 The European Society of Cardiology

Can improved quality of care reduce the costs of managing angina pectoris?

J. G. F. Cleland

CRI in Heart Failure, University of Glasgow Glasgow, U.K.

Correspondence: Dr John G. F. Cleland, CRI in Heart Failure, West Medical Building, University of Glasgow, Glasgow G12 8QQ, U.K.

Angina pectoris is a common symptom in patients over 50 years and is usually secondary to myocardial ischaemia resulting from coronary artery disease. The management of angina should be aimed at the maintenance or improvement of quality of life and delaying death. There are three strategies that may be adopted: medical, percutaneous transluminal coronary angioplasty and surgery. The majority of patients with angina can be controlled symptomatically most of the time by medical treatment alone. Any assessment of cost of treatment must take into account the cost of investigation, treatment, the morbidity associated with procedures or side effects of drugs, together with that of recurrent hospitalization, prolonged life and premature death. In addition, the duration of treatment has a major bearing on cost. Taking these factors into account, medical therapy is the least expensive short- and long-term treatment for angina pectoris. A medical approach to treatment also has considerable advantages over an interventional approach in terms of major morbidity. Only one of six surgical trials has demonstrated a survival benefit.

Key Words: Angina pectoris • PTCA • CABG • cost benefit


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