N = 92 respondents 4 Discussion In this patient survey, respondents with chronic angina who did not have a history of revascularization reported substantial improvement in QoL, angina frequency, and angina severity after initiating therapy with ranolazine. These improvements represent key treatment goals established by ACC/AHA guidelines for patients with chronic stable angina. Chronic stable angina can have a significant negative impact on daily activities and QoL of patients with CHD [13]. Invasive procedures such as PCI, coronary artery bypass grafting, and stenting

have been shown to improve QoL in patients with severe angina [14, 15]. However, many patients with stable ischemic heart disease may benefit from medical therapy [16]. Interestingly, among patients with BVD-523 supplier stable angina in the RITA-2 (Second Randomized Intervention Treatment of Angina) and COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluations) trials, early superiority of PCI over medical therapy in improving QoL had attenuated

by 3 years, although this observation may RXDX-106 cell line be attributable in part to patients assigned to medical therapy subsequently undergoing invasive treatment [15, 17]. In COURAGE, patients with more severe and more frequent angina were found to gain the greatest benefit from PCI [15]. Ranolazine can be used as initial anti-anginal therapy (particularly in situations where there is a contraindication to traditional anti-angina medications, or a concern about decreases in blood pressure or heart rate), or as add-on therapy to nitrates, β-blockers and calcium channel blockers [18]. Currently, ranolazine is indicated for patients with chronic stable angina, not for patients with stable ischemic heart disease. However, some suggest that there is a need for ranolazine in the broader CHD population, such as in those with cardiac X syndrome, who often have no response to conventional Thalidomide anti-anginal

therapy, or those with ischemic heart disease plus diabetes mellitus or arrthymias [19, 20]. While the high cost of ranolazine versus other anti-angina medications often leads to physicians opting to use ranolazine as a second-line or later treatment [18], the use of ranolazine in patients with poorly controlled angina is associated with decreases in revascularization rates, prescription costs, and a reduction in total care costs compared with patients receiving nitrates, β-blockers or calcium channel blockers [21]. Thus, the use of ranolazine can reduce the large financial burden chronic stable angina puts on the healthcare system. The improvements in QoL and severity of angina attacks reported by respondents on ranolazine in the present survey reflect the efficacy of outcomes tools such as the SAQ used to assess QoL in patients with chronic stable angina [13].