Management of angina

Current situation- Angina is very common - almost two million people in the UK have angina.

  • Thirty per cent of patients with recent-onset angina will suffer a major cardiac event (death, MI or revascularisation) within two years.

What is the evidence?

  • Most evidence suggests a beta-blocker should be the first-line prophylactic agent for regular symptom control.
  • Management options still being evaluated include spinal cord stimulation and transmural myocardial laser revascularisation (Curr Cardiol Rep 2006; 8: 272-6).
  • Ivabradine is the first selective sinus node If inhibitor. It reduces heart rate while maintaining myocardial contractility and atrioventricular conduction. It has been shown to be as effective as atenolol in patients with stable angina (Eur Heart J 2005; 26: 2,529-36).
  • Women with angina often present differently to men. Cardiac investigations such as exercise ECG are less specific and less sensitive in women (BMJ 2005; 331: 467-8).
  • Analysis of the IONA trial showed adding nicorandil to antianginal treatment is cost-effective as it leads to a lower incidence of cardiovascular disease (Heart 2006; 92: 619-24).

Implications for practice

  • There are still wide variations in the quality of care given to patients with angina.
  • A recent clinical review has highlighted that atenolol may be less useful than other beta-blockers, and other antihypertensive drugs, in reducing cardiovascular disease (CVD) in hypertensive patients (BMJ 2007; 334: 946-9). - A US study of men and women aged 45-84 years without clinical CVD showed only 40 per cent of patients with dyslipidaemia are reaching cholesterol target. Only about half of patients at high risk of CVD were treated with a statin (Circulation 2006; 113: 647-56).
  • Most GPs now have access to chest pain clinics.

Available guidelines

  • The SIGN guidelines say all patients with recent-onset angina should be considered for review by a cardiologist.
  • The NSF for CHD states that people with angina should be offered treatment to relieve their pain and to reduce the risk of coronary events.

Useful websites

Key points

  • CHD is the most common cause of death in the UK.
  • Many patients are still not reaching target cholesterol.
  • New treatments for angina are emerging.

Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners' PasTest 2006'

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

£20 notes spread out

VAT trap for PCNs could strip millions of pounds from general practice

Tens of millions of pounds could be stripped from general practice because work carried...

Talking General Practice logo

Podcast: Is the BMA representing GPs effectively, why GPs face a pension tax hit, and views on the workload crisis

In our regular news review the team discusses representation of GPs, a new survey...

Man sleeping

NICE guidance on insomnia backs app to replace sleeping pills

Hundreds of thousands of people with insomnia could be offered treatment via a mobile...

Health worker prepares a dose of COVID-19 vaccine

JCVI backs autumn COVID-19 booster campaign for high-risk adults and NHS staff

Frontline health and social care staff and adults at increased risk of severe illness...

GP consultation

Government accused of 'misleading' claims on general practice workforce

GP leaders have accused the government of making misleading claims about the general...

Consulting room door

LMC calls for enhanced access to be scrapped after abuse forces practice to close reception

A Midlands LMC has backed a practice forced to close its reception desk after abuse...