Surveillance decision

Surveillance decision

We will not update the guideline at this time.

We will amend the guideline to include a footnote to the recommendations for third‑line drug treatments (1.4.11, 1.4.12). This footnote is to make reference to the drug safety updates issued by the MHRA regarding the safety concerns with ivabradine (June 2014 and December 2014) and nicorandil (January 2016).

Reason for the decision

We found 44 new studies through surveillance of this guideline. None of the new evidence considered in surveillance of this guideline was thought to have an effect on current recommendations. Topic expert and stakeholder consultation feedback noted the drug safety updates would not affect recommendations however they would need to be acknowledged in the guideline. We will amend the guideline to include a footnote to the following areas of the guideline:

Anti‑anginal drug treatment

  • What is the clinical/cost effectiveness of ivabradine for the management of stable angina?

The footnote will make reference to the drug safety updates (June 2014 and December 2014) which highlight the risk of cardiac side‑effects and provide advice on the use of ivabradine for the treatment of angina.

  • What is the clinical/cost effectiveness of nicorandil for the management of stable angina?

The footnote will make reference to the drug safety update (January 2016) which highlights the risk of ulcer complications and provides advice on the use of nicorandil for stable angina.

Other clinical areas

We also found new evidence that was not thought to have an effect on current recommendations. This evidence related to diagnostic tests for stable angina, use of clopidogrel as an alternative to aspirin, effectiveness of cardiac rehabilitation programmes, effectiveness and safety of anti‑anginal drug treatments, revascularisation, prognostic risk stratification, pain interventions and cardiac syndrome X.

We did not find any new evidence related to general principles for treating people with stable angina or stable angina that has not responded to treatment.

For any new evidence relating to published or ongoing NICE technology appraisals, the guideline surveillance review deferred to the technology appraisal decision.

Overall decision

After considering all the new evidence and views of topic experts and stakeholders, we decided that no update is necessary for this guideline. We will amend the guideline to include a footnote to the recommendations for third‑line drug treatments.

See how we made the decision for further information.


This page was last updated: 03 April 2016