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Editorial
Improving quality of life in patients with angina
  1. R J P LEWIN
  1. British Heart Foundation Rehabilitation Research Unit
  2. Department of Health Studies, The University of York
  3. Genesis 6, York Science Park, Heslington, York YO10 5DG, UK
  4. emailrjpl1@york.ac.uk

https://doi.org/10.1136/hrt.82.6.654

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    Angina appears to have a particularly deleterious effect on a patient's quality of life. In a community survey in which the short form 36 (SF36) was administered to 1200 patients with 11 different chronic illnesses (including arthritis, sciatica, back pain, diabetes, depression, and stroke) only patients suffering from chronic anxiety reported a more severe detrimental effect on their general health.1 These patients were already receiving medical treatment, what more could have been done to help them?

    Interventional treatments

    Both coronary artery bypass grafting and angioplasty provide worthwhile reductions in symptoms and reduce early mortality in selected patients. The relative merits of each procedure are likely to be debated for some time but, whatever the final consensus, without a huge increase in resources, neither intervention will help most angina patients. In the UK there are approximately 1.6 million people with angina,2 of whom approximately 20% are referred to secondary care3 and 2% receive surgery or angioplasty each year.2 The long waiting lists for referral to secondary care, the scarcity of cardiologists, and an aging population make it likely that, for some time to come, the vast majority of patients with angina will remain unknown to secondary care and will not be considered for surgery or angioplasty.

    Care in the community

    Two recent community based studies have demonstrated that improved care can produce significant improvements in both clinical status and quality of life. In the first of these studies 688 primary care patients with angina were randomised to health education delivered by health visitors, or to routine medical care. The study produced improvements in the educational group in: activity levels, compliance with medication, lifestyle, and quality of life.4 In the second study, 1173 patients, of whom 50% had angina, were recruited from 19 general practices in Aberdeenshire.5 Practice nurses worked to a …

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