Importance to patients or the population.
What would be the impact on the population of any new or altered guidance? (for example, acceptability to patients, quality of life, morbidity or disease prevalence, severity of disease or mortality).
It would help optimise and standardise care for patients with stable angina and reduce variation.

It would provide a structured comprehensive MDT service accessible to stable angina patients.
Relevance to NICE guidance
How would the answer to this question change future NICE guidance (that is, generate new knowledge and/or evidence)?
There is no comprehensive evidence base currently.
Relevance to the NHS
What would be the impact on the NHS and (where relevant) the public sector of any new or altered guidance (for example, financial advantage, effect on staff, impact on strategic planning or service delivery)?
Identifying whether CR is clinically and cost effective for patients with stable angina, will help determine pathways for stable angina patients that will standardise their care, and reduce variation.
National priorities
Is the question relevant to a national priority area (such as a national service framework or white paper)? The relevant document should be specified.
The NSF for CHD was unable to clarify if CR was appropriate for stable angina patients; Consequently this research work could provide structure to National Frameworks.
Current evidence base
What are the problems with the current evidence base? (that is, why is further research required?) Reference should be made to the section of the full guideline that describes the current evidence base, including details of trials and systematic reviews.
There is no evidence that evaluates the whole package that CR could potentially provide.
Does the research recommendation address equality issues? For example, does it focus on groups that need special consideration, or focus on an intervention that is not available for use by people with certain disabilities?
Research can address equality issues e.g. evidence can minimise variation in the management and resulting outcomes for stable angina patients
Study design
It should also specify the most appropriate study design to address the proposed question(s). Primary research or secondary research (for example, systematic reviews) can be recommended.
Previous studies that have looked at aspects of cardiac rehabilitation to angina patients, have been small, with only short term follow up. Therefore it is suggested that a Randomised Control Study, with follow up at 5 years, will help to address this gap. Sample groups should be greater than 100.
Can the proposed research be carried out in a realistic timescale and at an acceptable cost? Are there any ethical or technical issues?
There is a large stable angina population across the UK as well as numerous establishments that currently provide CR services to stable angina patients.
Other comments
Any other important issues should be mentioned, such as potential funders or outcomes of previous attempts to address this issue or methodological problems. However, this is not a research protocol.
The University of Glamorgan has supported a similar research project that addressed the issue of Heart Failure and CR; they may consider supporting this research.

The British Heart Foundation may be a potential supporter
How important is the question to the overall guideline? The research recommendation should be categorised into one of the following categories of importance:
  • High: the research is essential to inform future updates of key recommendations in the guideline
  • Medium: the research is relevant to the recommendations in the guideline, but the research recommendations are not key to future updates
  • Low: the research is of interest and will fill existing evidence gaps.
Medium to high importance.

From: Appendix I, Criteria for selecting key priorities for implementation

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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