Updating guidelines on stable angina

β Blockers are the first choice for regular treatment

Doctors vary greatly in the way they assess and manage angina.1 The problem is common and serious so valid, clinically useful guidelines are welcome. The North of England Guidelines Group has an impressive record of producing rigorous guidelines for primary care. Today, the updated version of the group's 1996 guideline for managing stable angina is published in full on bmj.com.2 The new guideline extends the literature search from 1994 to 1997. It fulfils the 1996 commitment to an update after three years. How do the two versions compare?

Recommendations for assessment and referral have changed little from 1996. They are closely aligned with those in the British government's national service framework for coronary heart disease.3 The continuing challenge is to implement them. In particular, many areas of the United Kingdom will still find it difficult to meet the recommendation for prognostic exercise testing for all patients with stable angina.

There are few changes to the recommendations for …