LONDON (Reuters Health) - A self-management plan being tested in the UK appears to help patients newly diagnosed with angina improve their physical and psychological health.

Angina is a pain in the chest that occurs when blood flow, and thus oxygen flow, to the heart is insufficient. It is the main symptom of coronary artery disease. Stable angina occurs during exertion, and can usually be treated with rest and nitroglycerin medication. Unstable angina--which is much more serious and can signal an impending heart attack--involves complete blockage of blood flow in the heart, and generally occurs while a person is at rest.

Approximately 1.8 million people in the UK have angina, the authors note, and angina management programs offered in the hospital setting have been shown to improve quality of life.

In the current study, Dr. Robert J. P. Lewin from the University of York in the UK and colleagues assessed the effectiveness of a self-management angina program offered at a clinic. The study group included 142 patients with newly diagnosed angina who were randomly assigned to participate in the program, called "The Angina Plan," or to routine educational sessions (the "control" patients).

Patients enrolled in the program were given an angina workbook and an audiotape with relaxation techniques. A nurse conducted a 30- to 40-minute interview with each patient, during which common misconceptions about angina were addressed. The nurse also helped the patients to identify their modifiable heart disease risk factors.

At 6-month follow-up, patients in the program had experienced greater reductions in anxiety, depression, frequency of angina, use of angina medication and physical limitations than the control patients did, Lewin and colleagues report. Participation in the program was also associated with positive lifestyle changes such as eating a more healthy diet and increased daily walking.

The present results, published in a recent issue of the British Journal of General Practice, indicate that "a brief, cognitive-behavioural, nurse-facilitated, self-help intervention, added to a routine secondary prevention clinic, can reduce anxiety and depression and the self-report of angina and physical disability," the investigators conclude.

Further studies are needed to determine how effective the program would be for a broader patient population and if the beneficial effects persist beyond 6 months, the authors add.

SOURCE: British Journal of General Practice 2002;52:194-201.

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