RecommendationDo not offer the following interventions to manage stable angina:
  • transcutaneous electrical nerve stimulation (TENS)
  • enhanced external counterpulsation (EECP)
Relative values of different outcomesThe outcomes considered as important during the development of the review protocol for pain interventions included: improvement in anginal symptoms (angina frequency and nitroglycerin consumption), exercise tolerance, mortality, major cardiac events, hospitalisation, revascularisation, QoL and adverse events.
Trade off between clinical benefits and harmsOne RCT223 showed some improvement in angina and exercise test variables when compared to tablet placebo. However there was no improvement in angina or exercise test variables in two RCTs221,222 that compared acupuncture to sham acupuncture.

There is no other evidence of clinical benefit arising from the use of acupuncture in stable angina patients.
Economic considerationsNo published health-economic evaluation of acupuncture was included. The intervention is not cost-effective as it generates costs without being effective at improving the outcomes considered.
Quality of evidenceEvidence was obtained from 3 low quality RCTs221–223. Each of these RCTs had small sample size (<50 patients); outcomes were measured immediately after treatment with no longer term follow-up. The methodology of the trials was not well reported and the derived data was not analysable. Hence the GDG was not confident in the results of these trials.
Other considerationsThe GDG considered that people with angina which has not responded to drug or revascularisation options or for whom these options are inappropriate or undesirable present a significant clinical problem. They considered it important however, that interventions offered to these patients should have robust evidence base. The GDG did not consider that the evidence for acupuncture supported its use in people with angina. The GDG recognised that some people with angina may also experience chest pain that is not cardiac in origin and that acupuncture may have some role in these circumstances.

From: 18, Pain Interventions and Refractory angina

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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