A brief cognitive-behavioral intervention reduces hospital admissions in refractory angina patients

TY - JOUR

T1 - A brief cognitive-behavioral intervention reduces hospital admissions in refractory angina patients

AU - Moore, Roger K. G.

AU - Groves, David G.

AU - Bridson, John D.

AU - Grayson, Antony D.

AU - Wong, Helen

AU - Leach, Austin

AU - Lewin, Robert J. P.

AU - Chester, Michael R.

PY - 2007/3

Y1 - 2007/3

N2 - Chronic refractory angina is an increasingly prevalent, complex chronic pain condition, which results infrequent hospitalization for chest pain. We have previously shown that a novel outpatient cognitive-behavioral chronic disease management program (CB-CDMP) improves angina status and quality of life in such patients. In the present study of 271 chronic refractory angina patients enrolled in our CB-CDMP, total hospital admissions were reduced from 2.40 admissions per patient per year to 1.78 admissions per patient per year (P < 0.001). The rising trend of total hospital bed day occupancy prior to enrollment fell from 15.48 days per patient per year to a stable 10.34 days per patient per year (P < 0.001). There were 32 recorded myocardial infarctions prior to enrollment compared to eight in the year following enrollment (14% vs. 2.3%, P < 0.001) and overall mortality was lower that comparable groups treated with surgery. This study shows that educating patients and demystifying angina using a brief outpatient CB-CDMP produces an immediate and sustained reduction in hospital admission costs that represents a major potential health care saving. This benefit accrues in addition to the known effects of CB-CDMP on symptoms and quality of life. These data suggest that a CB-CDMP approach to symptom palliation represents a low cost alternative to palliative revascularization. (C) 2007 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

AB - Chronic refractory angina is an increasingly prevalent, complex chronic pain condition, which results infrequent hospitalization for chest pain. We have previously shown that a novel outpatient cognitive-behavioral chronic disease management program (CB-CDMP) improves angina status and quality of life in such patients. In the present study of 271 chronic refractory angina patients enrolled in our CB-CDMP, total hospital admissions were reduced from 2.40 admissions per patient per year to 1.78 admissions per patient per year (P < 0.001). The rising trend of total hospital bed day occupancy prior to enrollment fell from 15.48 days per patient per year to a stable 10.34 days per patient per year (P < 0.001). There were 32 recorded myocardial infarctions prior to enrollment compared to eight in the year following enrollment (14% vs. 2.3%, P < 0.001) and overall mortality was lower that comparable groups treated with surgery. This study shows that educating patients and demystifying angina using a brief outpatient CB-CDMP produces an immediate and sustained reduction in hospital admission costs that represents a major potential health care saving. This benefit accrues in addition to the known effects of CB-CDMP on symptoms and quality of life. These data suggest that a CB-CDMP approach to symptom palliation represents a low cost alternative to palliative revascularization. (C) 2007 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

KW - chronic refractory angina

KW - refractory angina

KW - stable angina

KW - angina pectoris

KW - myocardial infarction

KW - patient education

KW - rehabilitation

KW - hospital admissions

KW - mortality

KW - cognitive-behavioral therapy

KW - cost saving

KW - quality of life

KW - health economics

KW - ELECTRICAL-STIMULATION

KW - PECTORIS

KW - REHABILITATION

KW - MANAGEMENT

KW - QUALITY

KW - PROGRAM

U2 - 10.1016/j.jpainsymman.2006.10.009

DO - 10.1016/j.jpainsymman.2006.10.009

M3 - Article

SN - 0885-3924

VL - 33

SP - 310

EP - 316

JO - Journal of pain and symptom management

JF - Journal of pain and symptom management

IS - 3

ER -