Introduction

About two million people in England are believed to have (or to have had) angina: unlike other forms of coronary artery disease, angina is not declining in incidence.¹ Further, studies from primary care indicate that patients with a diagnosis of angina may have an annual cardiovascular death rate as high as 6.5%.²

The Euro Heart Survey documented considerable variation in the management of patients with new-onset stable angina, due in part to uncertainties about the prognostic impact of both drug treatment and revascularisation. These uncertainties were inevitable given that much of the evidence used to guide management was incomplete and out of date.

There have been further developments since the European Society of Cardiology guidelines on angina were published in 2006: these include better understanding of the efficacy and role of newer agents such as ivabradine and ranolazine, better understanding of secondary prevention measures, and refinements in the techniques and equipment used in primary coronary intervention.

The National Institute for Health and Clinical Excellence (NICE) has recently published a new guideline, CG126,³ to guide management of adults who have been diagnosed with stable angina due to atherosclerotic disease. Management of angina has many facets since clinicians need to manage the patient’s symptoms, to minimise the ischaemia and to improve the prognosis. Evidence-based therapy is needed, and clear thinking is required since angina patients are an ageing population often with co-morbidity such as diabetes, hypertension and heart failure.

This supplement covers aspects of this recent guidance that we consider to be particularly relevant and useful for our readers, taking into account some of the key areas for implementation identified by NICE. For example, one of the NICE guidance key priorities is to: “Offer people optimal drug treatment for the initial management of stable angina. Optimal drug treatment consists of one or two anti-anginal drugs as necessary plus drugs for secondary prevention of cardiovascular disease”.³

This supplement discusses mainly the medical management of stable angina, with a perspective given from both primary and secondary care. Other aspects of the NICE guidance including revascularisation, risk stratification, multi-disciplinary management and patient awareness of their condition, are only briefly covered. NICE has published a new care pathway algorithm to guide clinicians, who are advised to consult the guidance in full.³

Fundamental to the recent recommendations is the concept of patient-centred care. An article describing a community-based angina clinic is also included in this supplement to give a perspective of angina management in a ‘real world’ setting. High levels of patient satisfaction were reported and this model may be useful in meeting patient’s needs and, with the adoption of other strategies described in recent guidance, help overcome the suboptimal management of stable angina in the UK.

References

1. Lampe FC, Morris RW, Walker M et al. Trends in rates of different forms of diagnosed coronary heart disease, 1978 to 2000: prospective, population-based study of British men. BMJ 2005;330:1046. doi: 10.1136 bmj.330.7499.1046
2. Jones M, Rait G, Falconer J et al. Systematic review: prognosis of angina in primary care. Fam Pract 2006;23:520–8.
3. National Institute for Health and Clinical Excellence. NICE clinical guideline 126. Management of stable angina. London: National Institute for Health and Clinical Excellence, 2011. www.nice.org.uk/guidance/CG126