Methods to examine the prognosis of people with angina in primary care

Background Angina is an important condition associated with significant mortality and morbidity. The condition has largely been managed in primary care. There have been substantial recent changes in its management. This thesis will synthesize existing knowledge about the prognosis of angina in primary care and report the pilot of a new cohort study. Methods This thesis is based on multiple methods including a systematic review of prognosis, a cross sectional study measuring equity of access to angina treatments, a review of the literature on the ethics of searching patients records, a randomized controlled trial of recruitment methods (opt in and opt out), and qualitative methods to explore patients symptoms. I then analyse the feasibility and viability testing of a cohort study. Arising from this work, I discuss new methods for obtaining longitudinal data about angina in primary care. Results In the systematic review, I report yearly angina mortality rates of 2.8% to 6.6%. In the equity of access study, practices with a higher proportion of south Asians but not those with increased deprivation, had higher rates of angiography. The trial showed that the opt-in methodology is associated with a lower response rate and a bias towards healthier patients. The feasibility study shows that recruiting a cohort of people with angina would be feasible but probably not viable. I use preliminary data from trials to examine prognosis. Conclusion This thesis has been undertaken during a period of great change in the management of angina in primary care. The key finding is that a new cohort study of those with angina in primary care is probably not viable. However, I report other findings that will inform the design of new research on the prognosis of angina in primary care.EThOS - Electronic Theses Online ServiceGBUnited Kingdo