Cardiac Rehabilitation for the Treatment of Refractory Angina
Condition: Angina Pectoris; Coronary Disease
MeSH terms: Angina Pectoris; Coronary Disease
Study type: Interventional
Phase: Phase 3

Summary: 
      The purpose of this study is to determine whether cardiac rehabilitation is a successful
      treatment for refractory angina, in relation to improvements in cardiovascular risk factors,
      physical ability, symptomology, quality of life and psychological morbidity.
    

Detailed description: 
      The majority of patients presenting with angina pectoris resulting from coronary artery
      disease (CHD) are successfully treated with interventions including coronary artery bypass
      grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) and medical
      management. However, a growing number of patients experience persistent angina in spite of
      intervention and optimal medical treatment. Such patients are referred to as suffering from
      'refractory angina'.

      Currently, cardiac rehabilitation centres are reluctant to accept patients with ongoing
      angina or complicated cardiovascular history, in spite of the duration or stability of the
      symptoms. Indeed, angina and heart failure are often used to exclude patients from cardiac
      rehabilitation. However, in the recent updated American Heart Association (AHA)
      recommendations for exercise and training, cardiac rehabilitation and supervised exercise
      training is recommended for patients with ongoing angina, previous history of CABG, MI, PTCA
      and patients with existing cardiomyopathy in order to promote a reduction in myocardial
      ischaemia at rest and during sub-maximal exercise, while reducing the risk for the
      progression of CHD. Nevertheless, studies exploring the physiological and psychological
      impact of routinely available CR as a stand-alone intervention among refractory angina
      patients have not previously been undertaken. Until such studies are performed, CR
      practitioners will continue to refuse to accept refractory angina patients for participation
      in CR.

      Research questions:

        -  Is an eight-week cardiac rehabilitation exercise programme an appropriate treatment
           option for patients with refractory angina?

        -  Does an eight-week cardiac rehabilitation exercise programme improve the physical
           functioning and cardiovascular health of patients with refractory angina?

        -  Is symptom severity and frequency reduced following an eight-week cardiac rehabilitation
           exercise programme in patients with refractory angina?

        -  Does an eight-week cardiac rehabilitation exercise programme have any impact on anxiety,
           depression, cardiac anxiety and quality of life in patients with refractory angina?

        -  Are any physiological or psychological effects acquired by patients with refractory
           angina participating in a cardiac rehabilitation exercise programme maintained at an
           eight-week follow-up?

      The study is conceived as a randomised intervention-control study of a standard, routinely
      available Phase III hospital-based CR program among patients with refractory angina. Patients
      will be randomly assigned to an eight-week CR programme based at Harefield Hospital or
      symptom diary monitoring control group.
    

Intervention name(s): Cardiac rehabilitation
Intervention type(s): Behavioral
Intervention description(s): Phase III cardiac rehabilitation programme
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Refractory angina; Cardiac rehabilitation; Symptomology; Physical ability; Exercise; Psychology; Quality of life; Risk factors