NICE opens consultation on stable angina draft guideline
NICE has today (15 December) opened the public consultation on its draft clinical guideline on the management of stable angina. The draft guideline, which has been jointly developed by the National Clinical Guideline Centre (NCGC), sets out preliminary recommendations on what treatment and care the NHS should offer to people with a diagnosis of stable angina, including the use of anti-anginal drug treatment and surgery.
A chronic medical condition that can have a significant impact on quality of life, stable angina is predictable chest pain or discomfort that typically occurs with activity or stress and is caused by poor blood flow through the blood vessels of the heart. The most common cause of stable angina is coronary artery disease. This is where the development of cholesterol-rich deposits within the walls of coronary arteries (atherosclerosis) causes them to become progressively narrowed. This restricts blood supply to the heart (ischaemia), leading to the predictable chest discomfort on exertion characteristic of stable angina. If left untreated, stable angina can progress to acute coronary syndrome - a range of heart conditions from unstable angina to heart attacks.
The Health Survey for England (2006) found that about 8% of men and 3% of women aged between 55 and 64 years have, or have had angina. These figures rise to 14% and 8% respectively for people aged between 65 and 74 years. It is estimated that almost 2 million people in the UK have or have had angina. The aim of management is to get rid of, or minimise symptoms and to improve quality of life and long-term morbidity and mortality.
Dr Fergus Macbeth, NICE Clinical Practice Centre Director, said: "Heart disease is a major cause of preventable death in the UK. Earlier this year we published our clinical guideline on the diagnosis of chest pain of cardiac origin which emphasised the central role of the initial clinical assessment in diagnosing cardiac causes of chest pain. However, there is currently a great deal of variation in practice in key clinical areas for the management of stable angina where the evidence base is incomplete or contradictory. This applies particularly to the role of revascularization, for example percutaneous coronary intervention or coronary artery bypass grafting, for which symptomatic but not prognostic benefit has emerged as the predominant finding in contemporary clinical trials. This guideline provides very clear recommendations, based on the most up-to-date evidence, about what treatments, including revascularization, are most effective at reducing risk and improving outcomes for people with stable angina."
Draft recommendations for consultation include:
- Do not routinely offer percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) to people whose symptoms are controlled with drug treatment.
- Offer people optimal drug treatment (one or two anti-anginal drugs as necessary plus secondary prevention treatment) for initial management of stable angina.
- Consider CABG in preference to PCI for people with multi-vessel disease who have continuing symptoms despite optimal medical treatment and who are over 65 years and/or have diabetes.
- Consider PCI in preference to CABG for people who have continuing symptoms despite optimal medical treatment and who have single vessel disease or multi-vessel disease, including left main stem disease and the anatomy is suitable for the PCI.
- Consider CABG for people with single vessel disease or multi-vessel disease, including left main stem disease, and continuing symptoms despite optimal medical treatment if the anatomy is unsuitable for PCI.
- Offer people the opportunity to discuss the relative benefits and risks of continuing medical therapy, PCI and CABG with healthcare professionals to help them make an informed decision. Ensure patients are provided with balanced information.
Notes to Editors
About the draft guidance
1. The consultation on the draft guideline is available at http://guidance.nice.org.uk/CG/Wave17/25/Consultation/Latest and runs from Wednesday 15 December 2010 until Wednesday 9 February 2011.
2. NICE guidance on the assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin is available at http://guidance.nice.org.uk/CG95
3. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
4. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
5. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.
6. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 14 December 2010