Systematic review: Prognosis of angina in primary care

Abstract

Background. Angina is a common chronic condition, largely managed in primary care in the UK. Mortality data are predominately from population or hospital studies with little known about the prognosis of angina in general practice settings. Objective. To describe the prognosis of angina in patients identified in primary care. Methods. Design. Systematic review of cohort studies of angina in primary care. Data sources. Medline, PsycINFO, EMBASE, CINAHL, HMIC, WOS, IBSS, UK Na tional Research Register, notification via JISC, CHAIN. Review methods. Selection criteria. Cohort studies of patients with angina, with >12 months of follow-up, recruited within primary care. Validity assessment. Database searches and abstracts were reviewed independently by two authors. Papers were assessed according to criteria derived from the cohort methodological literature. Data abstraction. Data were abstracted by two reviewers. Data synthesis. Narrative summary. A quantitative synthesis was planned. Main outcome measures. Total and cardiovascular death; non-fatal myocardial infarction (MI). Results. Six studies fulfilled our selection criteria. The annual total mortality rate is 2.8-6.6%, an annual cardiovascular death rate of 1.4-6.5% and an annual non-fatal MI rate of 0.3-5.5%. A quantitative synthesis was not possible, because the studies were clinically heterogeneous. Conclusions. The primary studies have value in determining the prognosis of patients with angina recruited in general practice; however, the studies are old, have small numbers of events and are clinically heterogeneous. The contemporary prognosis of angina in primary care remains a key question, and further research is, therefore, required to estimate the prognosis of angina in this setting and its determinants. © 2006 Oxford University Press.