People with stable angina should be initially offered optimal drug treatment

Published on Monday, 01 August 2011 10:54
Posted by Scott Buckler

The initial management of people diagnosed with stable angina should be optimal drug treatment, rather than revascularisation procedures, according to NICE (August 1st)


Stable angina is caused by coronary artery disease, which is a condition where blood vessels narrow due to a build-up of fat. This leads to a reduction in the supply of blood and oxygen to the heart.

Common symptoms include pain and a feeling of discomfort or tightness in the chest. This can often spread to the jaw, back, shoulders and arms.

Current estimates suggest that almost 2 million people in England now have or have had angina, which includes around 8% of men and 3% of women aged between 55 and 64 years. These figures rise to 14% and 8% respectively for men and women aged between 65 and 74 years.

Being diagnosed with angina can impact on a person's quality of life by restricting their daily work and leisure activities.

Latest guidance from NICE recommends that people who are diagnosed with stable angina should initially be offered optimal drug treatment. This is to provide immediate symptom relief and to prevent future attacks of angina.

The optimal drug treatment should include one or two anti-anginal drugs. Additional drugs should also be offered for secondary prevention treatment, which aims to lower the risk of having a heart attack or stroke.

If a person does not respond to drug treatment, they should be offered one of two techniques for revascularisation to help increase the flow of blood to the heart and to relieve symptoms.

Imaging tests should be offered to determine whether revascularisation is necessary, and if so, which revascularisation procedure is best for the patient.

The techniques used are either coronary artery bypass surgery (CABG), which is surgery to bypass the narrowed artery in the heart, or percutaneous coronary intervention (PCI). This is a procedure that stretches and opens the part of the artery that has become narrowed.

Healthcare professionals should consider which of these procedures is most appropriate for patients with stable angina. They should also consider the risks and benefits of each procedure and take into account other medical conditions, such as diabetes, age, and the severity of symptoms.

NICE additionally recommends that a team of specialist healthcare professionals (multidisciplinary team) should meet regularly to discuss the risks and benefits of revascularisation and drug treatment for particular patients.

Professor Adam Timmis, Professor of Clinical Cardiology, said: "The main impact of this guideline will be its emphasis on 'optimal medical treatment' the initial treatment strategy for all patients with angina, with PCI and CABG reserved principally for patients who remain symptomatic.

"No longer will it be acceptable to undertake these revascularisation procedures in patients not receiving anti-anginal and secondary prevention treatment as detailed in this guideline."

Dr Fergus Macbeth, Director of the Clinical Practice Centre at NICE, commented that there "does not appear to be declining in incidence" in angina, unlike other manifestations of coronary artery disease.

He said: "This guideline provides very clear recommendations, based on the most up-to-date evidence, about what treatments, including revascularisation, are most effective at reducing risk and improving outcomes for people with stable angina."

NICE has produced a suite of tools to help with the implementation of this guideline. This includes a chest pain algorithm that links together algorithms on diagnosis, treatment and management from previous NICE guidance.

A factsheet on revascularisation has also been newly produced. This provides more information and details on the decision process that led to the guideline's recommendations on revascularisation.

The factsheet summarises the evidence examined to develop the recommendations, and also presents a detailed examination of literature.

Source: NICE

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