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Refractory angina is a growing challenge for palliative medicine: a systematic review of non-invasive interventions
- Source :
- BMJ Supportive & Palliative Care. 12:e869-e881
- Publication Year :
- 2020
- Publisher :
- BMJ, 2020.
-
Abstract
- BackgroundRefractory angina can have a significant effect on quality of life. Non-invasive interventions have been suggested but there are few guidelines on management. Our aim was to systematically review all studies that reported non-invasive interventions for refractory angina and report on their effectiveness and safety.MethodsWe performed a literature search of six databases and a grey literature search. Treatments considered first line or second line according to the European Society of Cardiology were excluded, as were interventions that had undergone review within the last 3 years. Design, setting and outcomes were extracted and quality was assessed. A narrative synthesis was undertaken, including an analysis of adverse effects.Results4476 studies were screened, 14 studies were included in our analysis. Interventions were specialist multidisciplinary programmes, transcutaneous electrical nerve stimulation (TENS), perhexiline, medical optimisation, morphine and intranasal alfentanil. The effects of specialist programmes and perhexiline treatment were mixed. Positive effects were reported with TENS, opioids and medical optimisation, with improvements in symptoms, exercise capacity and quality of life. No major adverse effects were noted in any of the treatments.ConclusionThere are non-invasive treatments for refractory angina that are overlooked by current guidelines. While the quality of these studies varies, positive changes have been reported in symptoms, exercise tolerance and quality of life with few adverse effects. There is a need for further research into these treatments which could be useful within the contexts of cardiology and palliative care.
- Subjects :
- medicine.medical_specialty
Palliative care
Perhexiline
Psychological intervention
Medicine (miscellaneous)
030204 cardiovascular system & hematology
Transcutaneous electrical nerve stimulation
law.invention
03 medical and health sciences
0302 clinical medicine
Quality of life (healthcare)
law
medicine
Humans
030212 general & internal medicine
Alfentanil
Palliative Medicine
Intensive care medicine
Adverse effect
Oncology (nursing)
business.industry
General Medicine
Medical–Surgical Nursing
Quality of Life
Transcutaneous Electric Nerve Stimulation
Refractory angina
business
medicine.drug
Subjects
Details
- ISSN :
- 20454368 and 2045435X
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- BMJ Supportive & Palliative Care
- Accession number :
- edsair.doi.dedup.....5a79ca1dabb177e076ece87f631e99b4