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- Andréll, Paulin, 1978, et al.
(author)
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HEALTH-RELATED QUALITY OF LIFE IN FIBROMYALGIA AND REFRACTORY ANGINA PECTORIS: A COMPARISON BETWEEN TWO CHRONIC NON-MALIGNANT PAIN DISORDERS
- 2014
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In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 46:4, s. 341-347
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Journal article (peer-reviewed)abstract
- Objective: To compare health-related quality of life in 2 different populations with chronic pain: patients with fibromyalgia and patients with refractory angina pectoris. Previous separate studies have indicated that these patient groups report different impacts of pain on health-related quality of life. Methods: The Short-Form 36 was used to assess health-related quality of life. In order to adjust for age and gender differences between the groups, both patient groups were compared with age- and gender-matched normative controls. The difference in health-related quality of life between the 2 patient groups was assessed by transforming the Short-Form 36 subscale scores to a z-score. Results: The patients with fibromyalgia (n=203) reported poorer health-related quality of life in all the subscale scores of Short-Form 36 (p < 0.05-0.0001) than the patients with refractory angina (n = 146) when both groups were compared with their corresponding normal population (z-score). Conclusion: Patients with fibromyalgia experience greater impairment in health-related quality of life compared with the normal population than do patients with refractory angina pectoris, despite the fact that the latter have a potentially life-threatening disease. The great impairment in health-related quality of life in patients with fibromyalgia should be taken into consideration when planning rehabilitation.
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- Andréll, Paulin, 1978, et al.
(author)
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Long-term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris--results from the European Angina Registry Link Study (EARL)
- 2010
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In: Heart. - 1355-6037. ; 96:14, s. 1132-1136
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To assess the long-term effect of spinal cord stimulation (SCS) on angina symptoms and quality of life in patients with refractory angina pectoris defined as severe angina due to coronary artery disease resistant to conventional pharmacological therapy and/or revascularisation. METHODS: During 2003-2005, all patients with refractory angina referred for SCS treatment at 10 European centres were consecutively included in the European registry for refractory angina (European Angina Registry Link, EARL), a prospective, 3-year follow-up study. In the present study, the SCS-treated patients were followed-up regarding angina symptoms and quality of life assessed was with a generic (Short Form 36, SF-36) and a disease-specific (Seattle Angina Questionnaire, SAQ) quality of life questionnaire. RESULTS: In total, 235 patients were included in the study. After screening, 121 patients were implanted and followed up 12.1 months after implantation. The implanted patients reported fewer angina attacks (p<0.0001), reduced short-acting nitrate consumption (p<0.0001) and improved Canadian Cardiovascular Society class (p<0.0001). Furthermore, quality of life was significantly improved in all dimensions of the SF-36 and the SAQ. Seven (5.8%) of the implanted patients died within 1 year of follow up. CONCLUSIONS: SCS treatment is associated with symptom relief and improved quality of life in patients with refractory angina pectoris suffering from severe coronary artery disease.
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- Andréll, Paulin, 1978
(author)
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Refractory angina pectoris. Patient characteristics, safety and long-term effects of spinal cord stimulation
- 2005
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Doctoral thesis (other academic/artistic)abstract
- Refractory angina pectoris has been defined as severe angina pectoris due to coronary artery disease which cannot be controlled by conventional pharmacological or surgical therapy. The epidemiology of this condition is virtually unknown. During the last decades, additional treatment options have been developed for this condition. One of these is spinal cord stimulation (SCS), which has been used for approximately 20 years as an additional symptom-relieving treatment for patients with severe angina pectoris. SCS has an anti-ischaemic effect and has been shown to be a safe and effective treatment modality. The occurrence of refractory angina pectoris among patients who had undergone coronary angiography was assessed in a defined geographic area. In order to characterise the patients with regard to concurrent diseases, treatment, functional class, quality of life, morbidity and fatality, the refractory angina patients were compared with patients with severe angina pectoris who were accepted for revascularisation. Within three years, 146 patients were identified, comprising 2.1% of all patients undergoing coronary angiography due to stable angina pectoris. The patients with refractory angina pectoris had more severe cardiac disease as well as coronary artery disease than the patients in the revascularisation group. Some of the patients in the refractory group appear to be in a fairly good condition with regard to extracardiac diseases but there is a subpopulation in the refractory group with severe cardiac as well as extracardiac diseases. The main reasons for rejection for revascularisation were unsuitable coronary anatomy and a potential risk of damaging existing grafts. After one year of follow-up the refractory patients had a higher fatality rate but a lower frequency of cerebrovascular morbidity than the revascularisation group. The refractory patients had more severe angina and lower quality of life with regard to physical function and impact of angina symptoms, compared with the revascularisation group. However, the mental health of the refractory patients was not affected compared with the revascularisation group. The patients in the so-called ESBY study (Electrical Stimulation versus Coronary Bypass Surgery in Severe Angina Pectoris, a randomised comparison of SCS and coronary artery bypass grafting (CABG) in 104 patients with severe angina pectoris and increased surgical risk) were followed up with regard to neurological and neuropsychological complications, morbidity and cost-effectiveness. There were more patients in the CABG group who developed neurological and neuropsychological complications than in the SCS group. Furthermore, presence of deep white matter disease on cerebral magnetic resonance imaging was shown to be a predictor of cerebrovascular complications after CABG. During two years of follow-up, health care costs and cardiac morbidity was lower in the SCS group than in the CABG group. However, the groups did not differ with regard to mortality or causes of death. There were no serious complications related to the SCS treatment. CONCLUSION Refractory angina pectoris appears to be a considerable problem. This patient group has a high fatality rate and low quality of life compared with revascularised patients. SCS, which is one of the recommended treatment option for these patients, was found to be safe (in terms of mortality, morbidity and absence of serious complications) and effective (in terms of symptom relief and cost-effectiveness) during long-term treatment. Furthermore, presence of deep white matter disease on cerebral magnetic resonance imaging seems to be a predictor of cerebrovascular complications after CABG.
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- Andrell, Paulin, et al.
(author)
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Smärta vid myokardischemi
- 2021
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In: Långvarig smärta- smärtmedicin vol 2. - Stockholm : Liber AB. - 9789147112883 ; , s. 673-86
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Book chapter (other academic/artistic)
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- Andréll, Paulin, 1978, et al.
(author)
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White matter disease in magnetic resonance imaging predicts cerebral complications after coronary artery bypass grafting
- 2005
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In: The Annals of thoracic surgery. - 1552-6259. ; 79:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: The aim of the present study was to assess neurologic and neuropsychologic complications in 104 patients randomized to coronary artery bypass grafting or spinal cord stimulation. An additional objective of the study was to assess whether preoperative white matter disease might predict cerebral complications, as previous studies have shown that there is a relationship between white matter disease and neuropsychologic decline after coronary artery bypass grafting. METHODS: The patients were subjected to neurologic examination before and six months after intervention. The patients underwent a cerebral magnetic resonance imaging before intervention and the presence of white matter disease was related to development of cerebral complications. RESULTS: More patients in the bypass group than in the spinal cord stimulation group developed focal cerebral ischemia (p < 0.05) and astheno-emotional disorder (p < 0.001). More patients with white matter disease undergoing bypass were affected by focal cerebral ischemia (p < 0.01) and astheno-emotional disorder (p < 0.001) after the intervention compared to patients with white matter disease undergoing spinal cord stimulation. In patients with no white matter disease there were no differences between the bypass group and spinal cord stimulation group with regard to cerebral complications. CONCLUSIONS: Patients undergoing bypass had more neurologic and neuropsychologic complications than patients undergoing spinal cord stimulation. Furthermore, patients with white matter disease were affected by cerebral complications in a higher extent after bypass than after spinal cord stimulation. Thus, preoperative assessment of white matter disease before undergoing coronary artery bypass grafting might predict the patient's risk of developing cerebral injury.
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- Borjesson, Mats, et al.
(author)
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Spinal cord stimulation in severe angina pectoris - A systematic review based on the Swedish Council on Technology assessment in health care report on long-standing pain
- 2008
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In: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 1872-6623 .- 0304-3959. ; 140:3, s. 501-508
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Journal article (peer-reviewed)abstract
- Patients who continue to stiffer from lasting and severely disabling angina pectoris despite Optimum drug treatment and who are not suitable candidates for invasive procedures,. suffer from a condition referred to as "chronic refractory angina pectoris". Based on the available data, spinal cord Stimulation, SCS, is considered Lis the first-fine additional treatment for these patients by the European Society or Cardiology. However, no systematic review of randomised controlled Studies has yet been published. A systematic literature research, 1966-2003, as part of the Swedish Board of Health and Welfare (SBU) report oil long-standing pain, and ail additional research covering the years 2003-2007, were carried out. Acute Studies, case reports and mechanistic reviews were excluded, and the remaining 43 Studies were graded for Study quality according to a modified Jadad score. The eight medium-to high-score studies formed the basis for Conclusions regarding the scientific evidence (strong, moderately strong or limited) for the efficacy of SCS. There is strong evidence that SCS gives rise to symptomatic benefits (decrease in anginal attacks) and improved quality of life in patients with severe angina pectoris. There is also a strong evidence that SCS call improve the functional status Of these patients, as illustrated by the improved exercise time oil treadmill or longer walking distance without angina. In addition, SCS does not seem to have any negative effects on mortality in these patients (limited scientific evidence). The complication rate was found to be acceptable. (C) 2008 Published by Elsevier B.V. on behalf of International Association for the Study of Pain.
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