ID# 1906278 National Joint Cardiology and Neuromodulation Multidisciplinary Service for Refractory Angina Management
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Authors
Poply K.
Choudry F.
Perera D.
Ramaseshan R.
Jones D.A.
Mathur A.
Mehta, V.
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2025
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Article
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Introduction: Refractory angina (RA) is defined as the occurrence of frequent angina attacks uncontrolled by optimal drug therapy, significantly limiting a patient's daily activities, with the presence of coronary artery disease rendering percutaneous coronary intervention or bypass surgery unsuitable.1 The European Society of Cardiologists estimates RA comprises 15% of total angina presentations with an annual incidence of 30,000-50,000. A recent study reported that over 70% of those patients are expected to survive 9 years following diagnosis. 2 Likewise, these patients were shown to have increased hospitalisation rates compared to myocardial infarction/mortality.3 In UK, RA management is underprovided due to limited specialist care provision. Consequently, patients commonly end up in a perpetual cycle of frequent local reviews alternating between outpatient clinics, A&E attendance and hospital admissions - incurring significant financial burden. With the increasing prevalence of RA and the introduction of novel therapeutics (spinal cord stimulation (SCS), coronary sinus reducer and research into cell and gene-based therapies), we have established the UK's only joint cardiology-neuromodulation pain multidisciplinary team (MDT) service that offers patients access to these new pathways and treatments. Method(s): The MDT (attended by interventional cardiologists and pain physicians with neuromodulation expertise) runs virtually once a month following a set pathway (Fig 1) and accepts national referrals. RA patients are screened before being presented to the MDT (inclusion criteria:18-85 years, diagnosis of refractory angina, CCS >III despite optimal medical and device therapy, no revascularisation options). At the MDT, patients are stratified to new treatment algorithms depending on their suitability for innovative clinical trials (REGENERATE COBRA4: an emerging therapy aimed at promoting angiogenesis and improving myocardial perfusion) followed by SCS or direct SCS (TA159). 5. All data is collected and clinical outcomes are recorded. Result(s): 1.Nurturing Innovation and collaboration: The joint MDT has cultivated expertise and delivery of innovation in a territory of unmet need. As a result, a cross speciality multi-disciplinary team exists today that works collaboratively linking key stakeholders (clinical and academia) to nurture SCS and other innovative therapies as part of RA MDT service. 2.Patient Benefit: Since 2022-24, 36 patients have been assessed in the MDT. All patients are currently on the research trial or clinical pathways for the long-term outcome data collection (cardiovascular and pain health QoL outcomes). Conclusion(s): This unique national MDT offers innovative treatments to refractory angina patients with the aim of improving their symptoms and quality of life to reduce the healthcare burden on the NHS through reduced outpatient appointments, A&E attendance and inpatient stays. Copyright © 2025
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Neuromodulation