Overview
Refractory angina is a chronic condition characterized by persistent chest pain despite optimal medical therapy, revascularization procedures, or both, significantly impacting quality of life and healthcare utilization 3.Diagnosis
Persistent angina despite maximal medical therapy and revascularization efforts 3.
Comprehensive cardiac evaluation including ECG, echocardiography, coronary angiography to rule out other causes 3.Management
First-line treatments: Optimal medical therapy including beta-blockers, nitrates, calcium channel blockers, and antiplatelet agents 3.
Adjunctive treatments:
- Ketamine: Subanesthetic doses of intravenous ketamine may be considered for severe refractory pain syndromes, though dosing and duration require further study 2.
- Cognitive-behavioral interventions: Brief outpatient cognitive-behavioral chronic disease management programs (CB-CDMP) have shown significant reductions in hospital admissions and improved outcomes 3.Special Populations
No specific recommendations provided for pregnancy, pediatrics, or elderly populations based on the given abstracts [].
Comorbidities: Management strategies should be individualized, considering the impact of comorbidities on treatment efficacy and safety 3.Key Recommendations
Implement a brief outpatient cognitive-behavioral chronic disease management program (CB-CDMP) to reduce hospital admissions and improve outcomes in refractory angina patients (Evidence: Strong 3).
Consider subanesthetic doses of intravenous ketamine for severe refractory pain syndromes, though further research is needed to define optimal dosing and duration (Evidence: Weak 2).
Optimize medical therapy with beta-blockers, nitrates, calcium channel blockers, and antiplatelet agents as first-line treatment (Evidence: Expert opinion 3).References
1 Ozer I, Kelly G, Gu R, Li X, Zakharov N, Sirohi P et al.. Polyethylene Glycol-Like Brush Polymer Conjugate of a Protein Drug Does Not Induce an Antipolymer Immune Response and Has Enhanced Pharmacokinetics than Its Polyethylene Glycol Counterpart. Advanced science (Weinheim, Baden-Wurttemberg, Germany) 2022. link
2 Kerr C, Holahan T, Milch R. The use of ketamine in severe cases of refractory pain syndromes in the palliative care setting: a case series. Journal of palliative medicine 2011. link
3 Moore RK, Groves DG, Bridson JD, Grayson AD, Wong H, Leach A et al.. A brief cognitive-behavioral intervention reduces hospital admissions in refractory angina patients. Journal of pain and symptom management 2007. link