Background
Coronary heart disease (CHD), predominantly due to myocardial infarction (MI), is the number one cause of death in the United Kingdom (British Heart Foundation). However, one of its most common initial manifestations, angina pectoris, remains as of yet understudied and its burden may be underappreciated. This is partly due to the fact that diagnosis of stable angina pectoris is based solely on the characterization of the pain as elicited by the doctor. Many patients with typical symptoms of stable angina are not diagnosed as angina (Phillpot et al., 2001) and factors such as sex, ethnicity and age may influence the physician’s final recommendations for diagnostic testing such as coronary angiography (Hemingway et al., 2003).
To determine the cumulative impact on patient outcome of missed opportunities for improving patient outcome, from the beginning to the end of the patient journey, across five of the most common symptomatic coronary presentations, assessing inequalities in care and outcome.
To determine at the level of the individual hospital the extent to which the organisation and processes of care have an impact on the patient journey. We will assess how variations measured at hospital level are impacted by the quality of primary care.
To establish the effectiveness and cost-effectiveness of a multi-faceted intervention targeting initial specialist management at hospital chest pain clinics of patients early in the symptomatic phase of the patient journey.
To determine whether novel biomarkers are a cost-effective addition to existing clinical information in predicting the progression of chronic stable angina to acute fatal and non-fatal events.
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