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States, accounting for 26.6% of all death in 2005. Another study in the United States estimates that coronary heart disease has the greatest prevalence amongst people aged 65 years or over (19.8% in 2010), followed by people who are aged between 45-64 (with a prevalence of 7.1%). The United
Kingdom also has a high mortality rate with 16% of all male deaths and 10% of all female deaths being attributable to coronary heart disease. However, it is worth noting that the mortality rate of coronary heart disease has been in steady decline since its peak in the 1960s, in contrast to the morbidity trend which has increased with increasing rates of revascularisation.
86:. Both PCI and CABG are effective at minimising symptoms and preventing progression of the symptoms. However, each therapy has its advantages and disadvantages when it comes to individual patient profile. PCI is one of the most commonly performed procedures on the heart. It is non-surgical, and so can be carried out safely in most patient groups. In high-risk patients, such as those over the age of 65, with diabetes, or with multi-vessel disorder, CABG may be the preferred technique. Although it is more invasive, in this group of patients, CABG has a higher long-term survival rate compared to PCI.
220:. The purpose of defining a scale for the severity of exertional angina was to evaluate the efficacy of medical and surgical therapy by comparing the patient’s status before and after therapeutic interventions. It was expected that a four-grade instead of a three-grade system would result in a greater discriminative power that would ensure better reproducibility. The grading scale was derived and modelled using some criteria from the
99:<0.01). Eight-year mortality rates were 20.5%, 24.1%, 40.4% and 35.3% among class I, II, III and IV patients, respectively. Limitations of the CCS grading system include the lack of consideration of confounding factors, such as drug therapy before exertion (particularly sublingual nitrates), and personal warm-up. The rate of worsening angina significantly also increased with increasing CCS class from I to III.
205:(CCS) is a national collaboration between cardiovascular clinicians and scientists, promoting cardiovascular health and care excellence through knowledge translation (dissemination of research and application of best practices), professional development, and leadership. The CCS developed the angina pectoris grading system in 1972; it was based on personal correspondence, information from
111:. They recommend no action by class I and II patients with stable angina, class III should consider mobility assistance from airport staff and in-flight supplemental oxygen therapy, and that class IV patients should ideally defer their travel plans or travel with a medical chaperone and use supplemental oxygen in-flight.
260:
In South Asian countries such as India, Bangladesh, Nepal and Sri Lanka, one aspect of healthcare expenditure on angina-affected households is out-of-pocket spending on medicine and primary outpatient care. This would point to greater reliance on trading household assets to finance health services,
228:
classes of organic heart diseases. The severity of angina on exertion was categorised by independent observers who detailed threshold activities for each level and noted the changes over time (different stages of angina pectoris are based on the level of difficulties patients have with carrying out
67:
The CCS grading system for angina is a clinical tool used by doctors to assess the degree of severity of a patient's angina. Whilst there are no defined therapy guidelines specific for each class, once the severity of the angina has been assessed, clinicians can use the framework to aid them in the
237:
Angina is not classified as a disease in itself, it refers to a person having chest pain with coronary heart disease, due to the lack of oxygen their myocardium as the presumed cause. A high mortality rate is associated with coronary heart disease. It is the leading cause of death in the United
94:
The CCS grading system is widely adopted in medical literature, with 656 manuscripts citing this grading system as of 2002 (87% were written in
English, 28% in German, 27% in Russian, 22% in French, 2% each in Scandinavian and Spanish, and 1% in Japanese). The CCS grading system has also been
402:
Serruys, Patrick W.; Morice, Marie-Claude; Kappetein, A. Pieter; Colombo, Antonio; Holmes, David R.; Mack, Michael J.; Ståhle, Elisabeth; Feldman, Ted E.; van den Brand, Marcel (2009-03-05). "Percutaneous
Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery
165:
Slight limitation of ordinary activities when they are performed rapidly, after meals, in cold, in wind, under emotional stress, during the first few hours after waking up, but also walking uphill, climbing more than one flight of ordinary stairs at a normal pace and in normal conditions.
852:
Reynolds, Matthew W.; Frame, Diana; Scheye, Rachel; Rose, M. Evelyn; George, Samuel; Watson, Jennifer B.; Hlatky, Mark A. (2004-10-01). "A systematic review of the economic burden of chronic angina".
270:
194:(Note: Class 0 is not an official part of the CCS functional classification of angina pectoris, however it has been mentioned in several sources, referring to myocardial ischemia without symptoms.)
253:
per patient is $ 27,003 and $ 28,670 at one and three years respectively, whereas three years’ worth of medical treatment costs $ 13,864 per patient. The mean weight cost per patient undergoing
887:
Caruba, Thibaut; Katsahian, Sandrine; Schramm, Catherine; Nelson, Anaïs
Charles; Durieux, Pierre; Bégué, Dominique; Juillière, Yves; Dubourg, Olivier; Danchin, Nicolas (2014-06-04).
95:
described in at least 18 medical and nursing textbooks. Increasing CCSA class was associated with increased long-term mortality, even after adjusting for baseline characteristics (
275:
221:
257:
without stent (PTCA) after three years of follow up is $ 14,277. The expenditure increases significantly when patients require additional revascularization during follow-up.
71:
In low severity cases, treatment will primarily consist of lifestyle changes, such as exercise, change in diet, smoking cessation. Often, this will be supplemented with
697:
464:
612:
68:
development of an individual treatment plan. This will also depend on unique patient factors, such as age, and risk of major cardiac complications.
246:
Chronic angina is often associated with substantial economic burden to the society, both in terms of healthcare expenditure and lost productivity.
557:
Smith, David; Toff, William; Joy, Michael; Dowdall, Nigel; Johnston, Raymond; Clark, Liz; Gibbs, Simon; Boon, Nick; Hackett, David (2010-08-01).
1016:
Cox, J; Naylor, CD (15 October 1992). "The
Canadian Cardiovascular Society grading scale for angina pectoris: is it time for refinements?".
378:
254:
79:
353:"Stable angina: management | Key-priorities-for-implementation | Guidance and guidelines | Clinical guideline [CG126] | NICE"
655:
78:
For higher severity cases, this medication may need to be combined with surgery. For example percutaneous coronary intervention
250:
209:
and international citation indexes searches. The grading system was published in 1976 and since has been cited over 650 times.
202:
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108:
83:
225:
500:
Kaul, Padma; Naylor, C. David; Armstrong, Paul W.; Mark, Daniel B.; Theroux, Pierre; Dagenais, Gilles R. (2009-07-01).
502:"Assessment of activity status and survival according to the Canadian Cardiovascular Society angina classification"
352:
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Having difficulties walking one or two blocks or climbing one flight of stairs at normal pace and conditions.
154:
Presence of angina during strenuous, rapid, or prolonged ordinary activity (walking or climbing the stairs).
328:
213:
795:
Bhatnagar, Prachi; Wickramasinghe, Kremlin; Williams, Julianne; Rayner, Mike; Townsend, Nick (2015-06-03).
212:
The committee's directive was to standardise the definition of terms used in reporting patients who had
900:
889:"Treatment for Stable Coronary Artery Disease: A Network Meta-Analysis of Cost-Effectiveness Studies"
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According to a network meta-analysis of cost-effectiveness studies the mean weight cost of
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465:"The Canadian Cardiovascular Society grading of angina pectoris revisited 30 years later"
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The CCS grading system for angina is, in part, used to evaluate fitness to fly by the
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ordinary activities; ordinary activities includes walking and climbing the stairs).
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774:"Prevalence of Coronary Heart Disease- United States, 2006-2010"
271:
European Heart Rhythm
Association score of atrial fibrillation
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which have long-term implications on the affected households.
613:"Canadian Cardiovascular Society grading of angina pectoris"
956:"The economic burden of angina on households in South Asia"
797:"The epidemiology of cardiovascular disease in the UK 2014"
559:"Fitness to fly for passengers with cardiovascular disease"
50:) is a classification system used to grade the severity of
21:
329:"Coronary angioplasty and stent insertion - NHS Choices"
719:
717:
276:
222:
25:
20:
618:. Canadian Cardiovascular Society. Archived from
8:
143:Mild myocardial ischemia with no symptoms.
954:Alam, Khurshid; Mahal, Ajay (2014-01-01).
778:Centers for Disease Control and Prevention
644:Gray, Rosaire; Pack, Louise (2010-12-16).
989:
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696:American Heart Association (2016-10-11).
533:
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118:
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48:CCS Functional Classification of Angina
29:grade the severity of exertional angina
188:No exertion needed to trigger angina.
17:
647:Cardiovascular Disease in the Elderly
377:Rimmerman, Curtis M (February 2013).
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854:The American Journal of Managed Care
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218:coronary artery bypass graft surgery
151:Angina only with strenuous exertion
506:The Canadian Journal of Cardiology
469:The Canadian Journal of Cardiology
304:"Angina - Treatment - NHS Choices"
255:percutaneous coronary intervention
14:
743:10.1161/CIRCULATIONAHA.108.764217
671:Canadian Cardiovascular Society.
82:or coronary artery bypass graft
405:New England Journal of Medicine
251:coronary artery bypass grafting
203:Canadian Cardiovascular Society
132:Description of Angina severity
37:Canadian Cardiovascular Society
162:Angina with moderate exertion
122:CCS grading of Angina pectoris
109:British Cardiovascular Society
42:(sometimes referred to as the
1:
518:10.1016/s0828-282x(09)70506-9
475:(4). Can J Cardiol: 371–379.
914:10.1371/journal.pone.0098371
813:10.1136/heartjnl-2015-307516
807:(15): heartjnl–2015–307516.
724:Bittner, Vera (2008-03-25).
383:www.clevelandclinicmeded.com
226:American Medical Association
103:Evaluation of fitness to fly
1030:10.7326/0003-4819-117-8-677
1018:Annals of Internal Medicine
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327:NHS Choices (2015-11-09).
302:NHS Choices (2015-04-29).
174:Angina with mild exertion
40:grading of angina pectoris
379:"Coronary Artery Disease"
131:
115:Functional classification
973:10.1186/1471-2458-14-179
463:Campeau, Lucien (2002).
44:CCS Angina Grading Scale
575:10.1136/hrt.2010.203091
214:coronary artery disease
860:(11 Suppl): S347–357.
1063:Diagnostic cardiology
698:"Angina (Chest Pain)"
625:on September 23, 2015
569:(Suppl 2): ii1–ii16.
417:10.1056/NEJMoa0804626
140:Asymptomatic Angina
905:2014PLoSO...998371C
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960:BMC Public Health
736:(12): 1505–1507.
726:"Angina Pectoris"
282:– a similar scale
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58:Medical use
707:2016-11-12
682:2016-11-12
677:www.ccs.ca
486:2016-11-12
426:2437/95138
403:Disease".
388:2016-11-12
363:2016-11-12
338:2016-11-12
333:www.nhs.uk
313:2016-11-12
308:www.nhs.uk
287:References
90:Acceptance
73:medication
982:1471-2458
923:1932-6203
866:1088-0224
821:1468-201X
752:0009-7322
583:1468-201X
526:1916-7075
435:0028-4793
63:Relevance
1057:Category
1046:46637191
1000:24548585
941:24896266
893:PLOS ONE
874:15603244
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599:16420591
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265:See also
224:and the
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629:Nov 12,
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1042:S2CID
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80:(PCI)
1034:PMID
996:PMID
978:ISSN
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862:ISSN
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631:2016
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216:and
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