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Table 16.10Intensive lifestyle programme vs. control for stable angina

Quality assessmentSummary of findings
No of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsIntensive lifestyle programmecontrol (5 years)Relative (95% CI)Absolute
Angina frequency (times per week) (follow-up 5 years; range of scores: -; better indicated by less)
Ornish 1998208randomised trialserious (a)no serious inconsistencyno serious indirectnessno serious imprecisionnone1814-MD 0.7 higher (0.9 lower to 2.3 higher)[plus sign in circle][plus sign in circle][plus sign in circle]

MODERATE
Chest pain duration (min) (follow-up 5 years; range of scores: -; better indicated by less)
Ornish 1998208randomised trialserious (a)no serious inconsistencyno serious indirectnessno serious imprecisionnone1814-MD 0.1 lower (1.64 lower to 1.44 higher)[plus sign in circle][plus sign in circle][plus sign in circle]

MODERATE
MI (follow-up 5 years)
Ornish 1998208randomised trialserious (a)no serious inconsistencyno serious indirectnessserious imprecision (b)none2/28 (7.1%)4/20 (20%)RR 0.36 (0.07 to 1.76)128 fewer per 1000 (from 186 fewer to 152 more)[plus sign in circle][plus sign in circle]○○

LOW
PTCA (follow-up 5 years)
Ornish 1998208randomised trialserious (a)no serious inconsistencyno serious indirectnessserious imprecision (b)none8/28 (28.6%)14/20 (70%)RR 0.41 (0.21 to 0.78)413 fewer per 1000 (from 154 fewer to 553 fewer)[plus sign in circle][plus sign in circle]○○

LOW
CABG (follow-up 5 years)
Ornish 1998208randomised trialserious (a)no serious inconsistencyno serious indirectnessserious imprecision (b)none2/28 (7.1%)5/20 (25%)RR 0.29 (0.06 to 1.33)178 fewer per 1000 (from 235 fewer to 83 more)[plus sign in circle][plus sign in circle]○○

LOW
Death (follow-up 5 years)
Ornish 1998208randomised trialserious (a)no serious inconsistencyno serious indirectnessserious imprecision (b)none2/28 (7.1%)1/20 (5%)RR 1.43 (0.14 to 14.7)21 more per 1000 (from 43 fewer to 685 more)[plus sign in circle][plus sign in circle]○○

LOW
a

Ornish 1998[202]: Strengths -RCT conducted from 1986 to 1992 using a randomised invitational design. Quantitative coronary arteriograms were blindly analysed without knowledge of group assignment. Baseline comparisons made. No loss to follow-up. Limitations- small sample size, Allocation concealment not reported.

b

95% CI around the pooled estimate of effect includes both: 1) no effect and 2) appreciable benefit or appreciable harm.

Ornish 1998[202]: Strengths -RCT conducted from 1986 to 1992 using a randomised invitational design. Quantitative coronary arteriograms were blindly analysed without knowledge of group assignment. Baseline comparisons made. No loss to follow-up. Limitations- small sample size, Allocation concealment not reported.

95% CI around the pooled estimate of effect includes both: 1) no effect and 2) appreciable benefit or appreciable harm.

From: 16, Rehabilitation

Cover of Stable Angina
Stable Angina: Methods, Evidence & Guidance [Internet].
NICE Clinical Guidelines, No. 126.
National Clinical Guidelines Centre (UK).
Copyright © 2011, National Clinical Guidelines Centre.

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