Clinical care for patients with recurrent myocardial ischemia in Germany—the VOICES trial

Dominik Berliner, Lars S. Maier, Ulrike Wollenberg, Roger Limberg, Jan D. Schmitto, Dirk Westermann, Johann Bauersachs


Background: Chronic ischemic heart disease is frequent and represents the most common cause of death in western countries. Angina pectoris, the clinical symptom of myocardial ischemia, is associated with increased morbidity and mortality also in patients without obstructive coronary artery disease. The aim of this study was to investigate the current care of patients with recurrent myocardial ischemia after ruling out significant coronary stenosis in the setting of outpatient care.
Methods: Data were obtained by a detailed and structured survey. German cardiologists in outpatient care were interviewed about the management and treatment of outpatients with recurrent angina pectoris after ruling out significant stenoses by coronary angiography. Items were analysed using rating scales [1–10] by means of descriptive methods. Absolute and relative frequency distribution was calculated for the characterisation of qualitative data and multiple-choice questions.
Results: The interviews of 731 cardiologic experts could be included in this analysis. The main results showed that history taking seems to be one major problem in those patients—more than 10% of the expert cardiologists admit that they do not perform a detailed history taking of patients with recurrent angina pectoris. While a classification of the symptoms by means of the CCS classification is rated as important such a classification is not used on a regular basis. Extra-cardiac causes are frequently not excluded before performing coronary angiography (>10% of the cases). A significant fraction (20%) of German cardiologists does not consider the initiation of a specific, antianginal medical treatment as their objective.
Conclusions: The trial revealed deficiencies in the history taking, the proper classification of the symptoms, and the initiation of an adequate drug therapy in patients with recurrent angina pectoris after exclusion of significant coronary stenoses.