Practice Guidelines

Management of stable angina: summary of NICE guidance

BMJ 2011; 343 doi: (Published 05 August 2011) Cite this as: BMJ 2011;343:d4147
  1. Norma O’ Flynn, clinical director1,
  2. Adam Timmis, professor of clinical cardiology2,
  3. Robert Henderson, consultant cardiologist3,
  4. Sharangini Rajesh, research fellow1,
  5. Elisabetta Fenu, senior health economist1
  6. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre Acute and Chronic Conditions, Royal College of Physicians, London NW1 4LE, UK
  2. 2Barts and the London, Queen Mary’s School of Medicine and Dentistry, London E1 2AD
  3. 3Trent Cardiac Centre, Nottingham University Hospitals, Nottingham NG5 1PB, UK
  1. Correspondence to: N O’Flynn norma.oflynn{at}

Stable angina is common. In England about 8% of men and 3% of women aged 55-64 years and about 14% of men and 8% of women aged 65-74 years have or have had angina.1 Stable angina is associated with a low but appreciable risk of acute coronary events and increased mortality. However, evidence exists of inconsistencies in management.2 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of stable angina.3 The diagnosis of stable angina is considered in an earlier NICE guideline.4


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Information and support for people with stable angina

  • Explain stable angina and its long term course and management. Inform about factors that can provoke angina—for example, exertion, emotional stress, exposure to cold, or eating a heavy meal. [Based on low to high quality evidence from qualitative studies and on the experience and opinion of the Guideline Development Group (GDG)]

  • Explore and correct any misconceptions about stable angina and its implications for daily activities, heart attack risk, and life expectancy. Individual patients may benefit from discussion about:

    • -Self management skills such as pacing their activities and goal setting

    • -Concerns about the impact of stress, anxiety, or depression on angina

    • -Advice about physical exertion including sexual activity.

[Based on low to high quality evidence from qualitative studies and experience and opinion of the GDG]

  • A useful source of information for patients is the British Heart Foundation (

  • Assess the person’s need for lifestyle advice—for example, about weight control, …

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