What studies examine quality of life in patients with microvascular (small vessel) angina?

From the Guidelines

The most recent and highest quality study, published in 2024, recommends medical therapy based on coronary functional test results to improve symptoms and quality of life in patients with microvascular angina 1.

Quality of Life Assessment

Studies examining quality of life in patients with microvascular angina typically use validated health-related quality of life questionnaires and patient-reported outcome measures. These studies often focus on how the condition affects physical functioning, pain levels, emotional well-being, and the ability to perform daily activities. Both observational studies and clinical trials have been conducted to assess quality of life in this patient population.

Common Questionnaires Used

Common questionnaires used in these studies include:

• The Short Form-36 (SF-36)
• The Seattle Angina Questionnaire (SAQ)
• The EuroQol 5-Dimension (EQ-5D) scale These tools help researchers quantify the impact of microvascular angina on various aspects of patients' lives, including physical limitations, angina frequency and stability, treatment satisfaction, and overall health perception.

Longitudinal Studies

Longitudinal studies are particularly valuable as they can track changes in quality of life over time and in response to different treatments. Some studies have also compared quality of life in patients with microvascular angina to those with obstructive coronary artery disease or healthy controls to highlight the specific challenges faced by this patient group.

Treatment Recommendations

According to the 2024 ESC guidelines, beta-blockers should be considered for symptom control in patients with microvascular angina associated with reduced coronary/myocardial blood flow reserve 1. Additionally, ACE-I should be considered for symptom control in patients with endothelial dysfunction 1. These recommendations are based on the latest evidence and prioritize improving symptoms and quality of life in patients with microvascular angina.

From the Research

Studies Examining Quality of Life in Patients with Microvascular Angina

• The study 2 assessed the effectiveness of ranolazine in improving angina scores and quality of life in patients with severe refractory angina due to microvascular angina, and found significant improvements in Quality of Life Enjoyment and Satisfaction Questionnaire Short Form scores and in 3 of the 4 domains of the Seattle Angina Questionnaire.
• The study 3 evaluated the effects of classical anti-ischemic drugs on symptoms and quality of life in patients with microvascular angina, and found that beta-blockers were more effective than other anti-ischemic drugs in improving angina symptoms, but the improvement of angina status did not seem to be mediated by changes in coronary microvascular function.
• The study 4 investigated the effects of aerobic physical training on myocardial perfusion, physical capacity, and quality of life in patients with primary microvascular angina, and found significant improvements in peak-VO2, reduction of summed difference scores, and improvement in quality of life scores.
• The study 5 evaluated the prognosis of microvascular angina in 86 Japanese patients, and found that the prognosis was favorable, with 98.9% of patients still alive at the end of the follow-up period, and 20.0% of patients free of antianginal medication.
• The systematic review 6 evaluated the quality of patient selection in treatment studies of microvascular angina, and found that only a quarter of the studies enrolled patients who met contemporary diagnostic criteria for definitive microvascular angina, and that there is a paucity of high-quality, randomized data to support any specific treatment intervention.

Key Findings

• Ranolazine may be an effective treatment option for improving symptom control and quality of life in patients with microvascular angina 2.
• Beta-blockers may be more effective than other anti-ischemic drugs in improving angina symptoms in patients with microvascular angina 3.
• Aerobic physical training may be a valid therapeutic option for improving myocardial perfusion, physical capacity, and quality of life in patients with primary microvascular angina 4.
• The prognosis of microvascular angina is generally favorable, with low mortality and morbidity rates 5.
• There is a need for larger, high-quality studies with robust selection criteria and long-term follow-up to support specific treatment interventions for microvascular angina 6.