Background Refractory angina is a chronic and potentially debilitating condition that is estimated to affect 30–50,000 new patients per year in Europe. It is likely to become more prevalent as the likelihood of survival with ischaemic heart disease increases. There is a demand for palliative intervention in patients whose quality of life is significantly affected and where conventional medical treatment and revascularisation are inadequate to control pain. Our aim was to systematically review all studies that report pharmacological and non-pharmacological interventions for refractory angina, and discuss palliative interventions appropriate for hospice and community-based care.
Methods We performed a literature search of six databases and a search of available grey literature. Studies relating to first- and second- line pharmacological treatments were excluded, as were interventions that had undergone systematic review within the last three years.
Results 4475 studies were screened, 37 studies were included in our analysis. Interventions were cardiac shockwave therapy (twenty two), transcutaneous electrical nerve stimulation (TENS) (four), perhexiline (two), optimal medical therapy (two), multi-disciplinary care programmes (two), psychotherapy (two), cardiac rehabilitation (one), morphine (one) and intranasal alfentanil (one). The majority of studies reported positive results, with improvements in pain, angina class, exercise tolerance and quality of life. Very few adverse effects were reported across all studies but quality assessment was varied and risk of bias was generally high.
Discussion There is a significant body of literature regarding interventions for refractory angina that is over-looked in current clinical practice. While the quality of these studies varies, improvements have been reported in symptom control and quality of life with few adverse effects. There is a need for further research into these interventions which could be useful within the contexts of cardiology and palliative care.