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Stable angina: management

Offering advice, information, and support

  • Include the person's family or carers in discussions when appropriate
  • Explain stable angina, factors provoking it, and its long-term course and management
  • Encourage questions and provide opportunities for the person to discuss concerns, ideas, 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
  • Discuss the purpose, risks, and benefits of treatment
  • Assess the need for lifestyle advice and psychological support. Offer interventions as necessary
  • Explore and address issues such as self-management skills, concerns about the impact of stress, anxiety, or depression on angina and physical exertion including sex
  • Advise the person to seek professional help if their angina suddenly worsens

General principles for treating stable angina

  • Do not:
    • exclude people from treatment based on their age alone
    • investigate or treat symptoms differently based on gender or ethnic group
    • offer vitamins or fish oil. Inform people there is no evidence that they help stable angina
    • offer transcutaneous electrical nerve stimulation (TENS), enhanced external counterpulsation (EECP), or acupuncture to manage stable angina

Short-acting nitrates for preventing and treating angina

  • Advise people:
    • how to administer short-acting nitrates
    • to use immediately before planned exercise or exertion
    • side-effects such as flushing, headache, and light-headedness may occur
    • to sit down or hold on to something if feeling light-headed
  • When used to treat episodes of angina advise people:
    • to repeat the dose after 5 minutes if the pain has not gone
    • to call an emergency ambulance if the pain has not gone 5 minutes after the second dose

Care pathway

Please click on algorithm to enlarge

Care Pathway

Optimal drug treatment

  • Optimal drug treatment is one or two anti-anginal drugs as necessary plus drugs for secondary prevention of cardiovascular disease
  • Provide information about drugs in line with 'Medicines adherence' (NICE clinical guideline 76)

Anti-anginal drug treatment

  • Advise people that anti-anginal drug treatment aims to prevent episodes of angina and secondary prevention aims to prevent cardiovascular events such as heart attack and stroke
  • Discuss how side-effects of drug treatment might affect daily activities, and the importance of taking drug treatment regularly
  • Review response to treatment, including any side effects, 2–4 weeks after starting or changing drug treatment
  • Titrate dosage against symptoms up to the maximum tolerable dosage

Secondary prevention

  • Consider aspirin 75 mg daily. Take into account risk of bleeding and comorbidities
  • Offer statins in line with 'Lipid modification' (NICE clinical guideline 67)
  • Offer treatment for high blood pressure in line with 'Hypertension' (NICE clinical guideline 34)

full guideline available from…
National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT
www.nice.org.uk/guidance/CG126

National Institute for Health and Care Excellence. Stable angina: management. July 2011
First included: October 2011.