The Benefits of Optimal Medical Therapy in Patients with Stable Angina Pectoris in Private Healthcare Settings in South Africa

[Speaker] Lehlohonolo J. Mathibe:1
[Co-author] Pride Tlhakudi:2
1:Division of Pharmacology (Therapeutics), University of KwaZulu-Natal, South Africa, 2:Health Economics, Novo Nordisk, Johannesburg, South Africa

Angina pectoris is a cardiovascular condition which continues to affect multitudes of people around the world. It is characterised by a thoracic pain radiating to the jaws, shoulders and arms.

In this study, the management of stable angina pectoris in private healthcare settings, in South Africa (SA), was investigated. In particular, the frequency of optimum medical therapy (OMT) vs surgical interventions, when used as first line therapy, was reviewed.

This was a retrospective, and descriptive study carried out using records of patients in the private healthcare settings. All cases which were authorised for reimbursement by medical aid scheme for revascularisation between 2009 and 2014 were retrieved and a database was created.

Nine hundred and twenty-two (N = 922) records of patients, consisting of 585 males (with average age of 64.7 years; sd 12.9) and 337 females (with average age of 65.5 years; sd 14.3), met the inclusion criteria. Only 15.8% of these participants were on OMT (which consisted of a β adrenergic blocker, calcium channel blocker and a nitrate). This study showed that OMT, when used as a first choice, does not only reduce the need for surgery, but it also significantly (p < 0.05) increases the period between the first and the second surgical interventions by virtually three years (±34 months). The percutaneous coronary interventions (PCIs) - which consisted of drug eluting stents (DES), bare metal stents (BMS) and dual therapy stent (DTS) - were the most preferred surgical methods. However on average, coronary artery bypass graft (CABG) resulted in a longer period (i.e., ±138 months) between the first and the second interventions as compared to the PCIs (i.e., ±36 months), and the difference (±102 months) was statistically significantly (p < 0.0001).

In the private health care settings in South Africa, an affordable medical therapy is not optimized. Revascularisation is still the most preferred treatment option for stable angina patients. This practice continues in spite of evidence pointing to the contrary.
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