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Title: Burden of Angina is Underestimated in General Population

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BMJ 2003;327;895.
10/20/2003 11:02:00 AM
By Joene Hendry

Primary care disease registers underestimate the burden of angina in the general population, according to results of a population-based study of non-industrial civil servants in the United Kingdom. At 5 intervals between 1985 and 1999, Harry Hemingway, a reader in clinical epidemiology at University College London Medical School, United Kingdom, and colleagues collected questionnaire data as well as general practitioner and hospital records to determine the prognosis of angina among over 10,000 civil servants, aged 35 to 55 years, who were and were not diagnosed with angina by a physician. The participants underwent a resting 12-lead electrocardiogram at 3 intervals during the 11-year study. The investigators classified angina in the study population according to doctors' findings, evidence of an abnormal electrocardiogram, and the results of the 7-item Rose angina questionnaires, completed at all 5 testing intervals, which defines angina independent of medical care. Overall, 11.4% developed angina and 70% of these individuals had no evidence of a physician diagnosis at the time of the initial report of angina. The investigators found that the age and sex adjusted odds ratio for impaired physical functioning at the last testing interval was 2.36 among participants without a physician diagnosis compared with 3.19 among those with a physician diagnosis of angina. A separate analysis revealed a similar prospective impact of angina on the functional impairment of women and men. The investigators found that the absolute risk of non-fatal myocardial infarction was similar between individuals without a physician diagnosis (15%) and those with a diagnosis (16%) of angina. However, the age and sex adjusted hazard ratio for mortality was 2.37 among the study participants with abnormal electrocardiograms and undiagnosed angina compared with 1.83 among those with diagnosed angina and abnormal study electrocardiograms. The authors conclude that, "reducing the population burden of angina requires consideration of people who have yet to be given a diagnosis."

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