7 September 2012

Improving the Diagnosis and Management of Stable Angina

NICE has produced a quality standard for stable angina that aims to help improve the diagnosis, care and treatment of the condition.

Angina is prevalent in an estimated 1 in every 12 men and 1 in every 30 women aged between 55 and 64 in England, rising to 1 in every 7 men and 1 in every 12 women who are over 65.

There are currently estimated to be around 2 million people in England who have or have had angina.

Symptoms of stable angina gradually develop over time and follow a predictable pattern. Clinical management of the condition aims to stop or minimise symptoms, and to improve quality of life, and long-term morbidity and mortality.

NICE's quality standard on stable angina contains five statements that cover the full pathway of care for the condition.

These include that people with features of typical or atypical angina and an estimated likelihood of coronary artery disease of 10-90% are offered diagnostic investigation according to that likelihood.

Further statements say that people with stable angina are offered a short-acting nitrate and either a beta-blocker or calcium-channel blocker as first-line treatment.

The standard additionally states that people with stable angina are prescribed a short-acting nitrate and 1 or 2 anti-anginal drugs as necessary before revascularisation is considered.

Peter Weissberg, Medical Director at the British Heart Foundation, said: "These quality standards for stable angina are both timely and important.

"Angina, usually experienced as discomfort in the chest on exertion, can be the first and only warning that someone has coronary artery disease and is at risk of a heart attack.

"Through medical research we have developed a range of tests and treatments to effectively identify and care for patients with angina, but it is essential that robust standards and guidelines are followed to confirm or refute the presence of coronary artery disease in someone experiencing chest pain."

NICE has produced support for commissioners to help implement the quality standard and the recommendations from the NICE clinical guideline on stable angina.

The support tool covers the commissioning implications and potential resource impact of implementing each of the five statements in the quality standard.