RecommendationClearly explain stable angina to the person, including factors that can provoke angina (for example, exertion, emotional stress, exposure to cold, eating a heavy meal) and its long-term course and management. Where relevant, involve the person’s family or carers in the discussion.
Encourage the person with stable angina to ask questions about their angina and its treatment. Provide opportunities for them to voice their concerns and fears.
Discuss the person’s, and if appropriate, their family or carer’s ideas, concerns and expectations about their condition, prognosis and treatment. Explore and address any misconceptions about stable angina and its implications for daily activities, heart attack risk and life expectancy.
Advise the person with stable angina to seek professional help if there is a sudden worsening in the frequency or severity of their angina.
Discuss with the person the purpose and any risks and benefits of their treatment.
Explore and address issues according to the person’s needs, which may include:
  • self-management skills such as pacing their activities and goal setting
  • concerns about the impact of stress, anxiety or depression on angina
  • advice about physical exertion including sexual activity.
Advise people that the aim of anti-anginal drug treatment is to prevent episodes of angina and the aim of secondary prevention treatment is to prevent cardiovascular events such as heart attack and stroke.
Relative values of different outcomesThis review was conducted to eleicit the information needs of patients. As such the outcomes could not be pre—determined. The GDG did consider patient neds might include information on: the condition, the symptoms, prognosis, treatment (choice of treatment and side effects), need and type of rehabilitation, prevention, activities for daily living, QoL.
Evidence based on qualitative studies confirmed that the following information themes are considered important by stable angina patients: causes of angina and management, identification and management of risk factors, organisation of medical services, physical activity, information to family members, education on stress management, forum/groups for discussion of the condition, self-management programmes, management of anger and depression, preference for educator for delivery of information.
Trade off between clinical benefits and harmsThe studies reviewed do not report on harms arising from patient information. The GDG considered that patients had a right to information about their condition and did not believe there were harms that would outweigh benefits.
Economic considerationsNo economic evidence was found. There is a negligible cost of staff time associated with providing information to the patient. However the benefits are likely to offset the minimal costs.
Quality of evidenceEvidence from 4 moderate quality studies. One UK study. No specific evidence on needs of subgroups was found.
Other considerationsThe GDG used evidence from the studies, and their own experiences as professionals and patients to develop the recommendations about information required for patients. The GDG considered that information should be individualised to each patient and that exploring a patient’s concerns and ideas about their condition and its treatment is pivotal in addressing their information needs. The GDG were also aware of resources such as those developed by the British Heart Foundation, which provide information on the heart and heart conditions that will be useful to patients. The GDG noted that people interviewed were concerned about stress and anger and that these concerns underlie common perceptions about angina and heart disease. The GDG considered that information and advice on stress, anxiety, and depression is not necessarily required by all patients but healthcare professionals may need to address these areas with many patients.
The GDG considered it particularly important that patients be advised about appropriate physical activity including sexual activity. The GDG considered it important that patients were given information about risks and benefits of treatments.
The GDG considered it important that patients were informed what different drugs and revascularisation strategies would achieve e.g. improve symptoms and this recommendation was informed by the evidence reviews of interventions.

From: 5, Patient Information

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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