This month’s double Back to Basics feature focuses on coronary artery disease and understanding the differences between stable angina, unstable angina, STEMI and NSTEMI, and their secondary prevention and management in primary care.
Back to Basics: Recognising different types of coronary artery disease 2
Back to Basics: Recognising different types of coronary artery disease 1
This month’s double Back to Basics feature focuses on coronary artery disease and understanding the differences between stable angina, unstable angina, STEMI and NSTEMI, and their secondary prevention and management in primary care.
Optimising medical therapy for stable angina patients
Percutaneous coronary intervention (PCI) has no benefit over optimising medical therapy (OMT) in the management of patients with chronic stable angina. Guidelines recommend an initial OMT approach; however, the use of medicines remains suboptimal. The aim of this study was to test whether a primary care clinical pharmacist service could enhance the management of patients with chronic stable angina.
Guidance on optimal management of stable angina in general practice
For most people symptoms can be controlled by optimal medical management and healthy lifestyle choices. Revascularisation gives symptom relief but is not without risk, and its long-term benefits remain uncertain.
Stable angina: the no tears review
Approximately 5% of adults aged over 40 years have stable angina, appear on our coronary heart disease (CHD) registers and are recalled at least annually for reviews. People with angina are often prescribed four or more regular items, and it is widely believed that patients are more likely to take their medicines effectively when they agree to their prescription and feel involved in decision-making. The medication review involves patients in prescribing decisions, and supports them in taking their medicines most effectively, so improving health outcomes and satisfaction with their care.
On the beat: Controlling heart rate in angina and heart failure
Controlling heart rate is a key element of good care of patients with angina or heart failure. In this article we explore the benefit of effective heart rate control to reduce hospitalisation and alleviate symptoms. Measuring heart rate is simple, and can provide valuable benefits for many patients.
Heart rate control in heart failure and angina, and its benefits
In heart failure, heart rate control may improve mortality and the need for hospitalisation. In angina, heart rate control improves symptoms and reduces the need for PCI
Making the most of angina management programmes in patients with refractory angina
Refractory angina affects approximately 5-10% of patients with angina. Sufferers are significantly disabled by their symptoms, which are made worse by fears about what is happening to them. They are frequent attenders in GP surgeries, hospital outpatient departments and emergency admissions units. Patients who take part in an Angina Management Programme (AMP) that provides education, stress management and relaxation feel better, live longer and are able to avoid unnecessary invasive tests and palliative revascularisation procedures. AMPs can be effectively commissioned and delivered in primary care.
Taking the heartache out of angina
Angina is common, particularly among older people. It affects around one in ten women and up to one in five men aged 65 and over. The good news is that the outlook for patients with stable angina is relatively good as long as we help them to take appropriate prevention measures. Unstable angina has a more variable prognosis, but effective prevention can again help to reduce the risk of heart attack. How can we optimise the diagnosis and ongoing care for the many people in our practices with angina?
When is coronary revascularisation superior to medical therapy in patients with angina?
Starting on your GTN tablets or spray
GTN (glyceryl trinitrate) in tablet or spray form is used for the immediate relief of chest pain due to angina. The tablets have a short shelf-life and should be thrown away eight weeks after opening the bottle. The spray lasts longer, but you need to check the expiry date on the bottle. Angina is a […]
Procoralan (Ivabradine): A New Treatment Option for Angina
Angina is on the increase as people live longer. It is the most common symptom of ischaemic heart disease and occurs when the arteries are no longer able to supply the heart with enough blood to meet its demands. Treatment aims to restore the balance between oxygen supply and demand, to relieve the pain as quickly as possible and prevent further angina attacks, to treat the risk factors, limit the progression of coronary artery disease and reduce the risk of a heart attack. Procoralan (ivabradine) works by specifically inhibiting the If or ‘funny’ channel in the sinoatrial node of the heart (also known as the cardiac pacemaker) to reduce the resting heart rate, matching the efficacy of beta-blockers without their side-effects.
