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The management of patients with stable angina presents clinicians and healthcare providers with a major clinical and health economic challenge. The Health Survey for England 2006 reported that around 8% of men and 3% of women aged between 55 and 64 years have or have had angina, and these figures rise to 14% and 8% respectively for men and women aged between 65 and 74 years.1 Large randomised trials suggest that people with stable angina have a good prognosis with an all-cause mortality of around 1.5% a year,2 but population-based studies have reported substantially higher annual cardiovascular death rates.3 4 Moreover, a diagnosis of angina has a significant impact on quality of life, which deteriorates progressively in proportion to the severity of symptoms.5
The Euro Heart survey of 3779 patients with a new diagnosis of stable angina disclosed considerable differences between participating countries in the prescription of anti-anginal drugs, use of non-invasive and invasive investigations and rates of myocardial revascularisation.6 This variation in practice reflects uncertainty about the appropriate management of patients with stable angina and highlights the need for evidence-based clinical guidelines.
The recently published NICE clinical guideline (CG126) on the management of stable angina offers advice on treatment of episodes of angina, anti-anginal drug treatment, secondary prevention, the role of risk scores and non-invasive functional investigation, myocardial revascularisation, life-style adjustments and the management of refractory angina. Detailed review of the evidence for the guideline can be found in the full version (http://guidance.nice.org.uk/CG126) and this article summarises the most important recommendations (see box 1). Other NICE clinical guidelines deal with the diagnosis of …