To the Editor: In his editorial on “Alternative treatments for angina”,¹ Dr Lanza makes no mention of the value of rehabilitation, especially patient and carer education, in improving quality of life. Given the central role of patient education in (refractory) angina management, this requires comment.

Damaging misconceptions are common in people with angina and their carers, and education is a potent and critically important intervention that may have profound effects on understanding, behaviour and quality of life.^2,3 It is for this reason that both the ESC and the AHA/ACC/ACIP/ASM stable angina management guidelines recommend a continuous process of identifying and clarifying misconceptions throughout care.^4,5 Similarly, the ESC Refractory Angina Study Group came to the same conclusion for the same reason.⁶ It is perhaps because rehabilitation and patient education are not regarded as “treatment” that this most important aspect of good clinical care is so often neglected.

It is of great concern that this oversight seems to characterise each point of the patient’s journey. The ACC/AHA guidance has observed that, “…healthcare providers tend to focus on diagnostic and therapeutic interventions, often overlooking critically important aspects of high-quality care. Chief among these neglected areas is the education of patients.”⁵

This point was vividly illustrated in an editorial on the British Cardiac Intervention Society …