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Articles by J. A. Spertus
Total Records ( 2 ) for J. A. Spertus
  J. F Beltrame , A. J Weekes , C Morgan , R Tavella and J. A. Spertus

Background  Angina, the cardinal symptom of coronary artery disease (CAD), is amenable to a range of therapies, and its routine assessment is considered a performance measure of quality. However, the prevalence of frequent angina among outpatients with CAD is unknown.

Methods  The Coronary Artery Disease in General Practice (CADENCE) Study utilized a cluster-stratified, cross-sectional design to examine angina frequency in patients with stable angina attending Australian primary care practices. The 207 participating primary care practitioners recruited 2031 consecutive patients, irrespective of the purpose of their visit. Angina frequency was quantified with the Seattle Angina Questionnaire (SAQ), and weekly angina was defined as having 1 or more episodes per week over the preceding 4 weeks [hereinafter, "weekly (≥1) angina"].

Results  Among primary care practice patients with stable angina, 29% (95% confidence interval [CI], 26%-31%) experienced weekly (≥1) angina, which was associated with greater physical limitations and worse quality of life (24% and 27% lower SAQ scores, respectively; P < .05) compared with those with minimal angina (angina less than once a week over the preceding 4 weeks). The proportion of patients with weekly (≥1) angina within a clinic ranged from none (14% of clinics) to more than 50% (18% of clinics). Patient characteristics associated with weekly (≥1) angina included female sex (odds ratio [OR], 1.42; 95% CI, 1.13-1.78), a history of heart failure (OR, 1.59; 95% CI, 1.22-2.08), and peripheral artery disease (OR 1.89; 95% CI, 1.42-2.51; P < .001 for all comparisons).

Conclusions  Almost 1 in 3 patients with stable angina attending primary care practices had angina at least once a week, which was associated with worse quality of life. Moreover, weekly (≥1) angina varied considerably across clinics, possibly reflecting variability in the identification and management of angina. The potential role of an angina performance measure to improve patients' outcomes, including symptom control, warrants further consideration.

Trial Registration Identifier: ACTRN12608000347369

  J. A Grantham , P. G Jones , L Cannon and J. A. Spertus

Background— Data on the health status benefits of percutaneous coronary intervention for coronary chronic total occlusions (CTOs), a principal indication for the procedure, are lacking.

Methods and Results— In the FlowCardia Approach to CTO Recanalization (FACTOR) trial, patients (n=125) completed the Seattle Angina Questionnaire (SAQ) at baseline and 1 month after percutaneous coronary intervenion. One-month health status outcomes were compared by multivariable analysis, adjusting for group differences between those whose CTO was successfully and unsuccessfully recanalized. These changes were also analyzed according to baseline symptoms. Procedural success was 55% (n=64) and independently associated with angina relief (difference between those with successful and unsuccessful percutaneous coronary intervention [] in SAQ angina frequency=9.5 points; 95% confidence interval, 1.6 to 17.5; P=0.019), improved physical function ( in SAQ physical limitation=13.1 points; 95% confidence interval, 5.1 to 21.1; P=0.001), and enhanced quality of life ( in SAQ quality of life [QoL]=20.3 points; 95% confidence interval, 11.9 to 28.6; P<0.001). The benefit of successful percutaneous coronary intervention was greatest in symptomatic patients as compared with asymptomatic patients although statistically significantly so only for QoL (SAQ angina frequency domain=10.3 versus 4.3 points, P=0.51, physical limitation =15.9 versus 6.3 points, P=0.25; QoL=27.3 versus 8.5 points, P=0.047).

Conclusions— Successful CTO recanalization is associated with significant early improvements in patient symptoms, function, and QoL but only among symptomatic patients. Percutaneous treatment of a CTO offers the potential to provide significant health status benefits in symptomatic patients.

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