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Education And Debate

North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of stable angina

BMJ 1996; 312 doi: (Published 30 March 1996) Cite this as: BMJ 1996;312:827
  1. Martin Eccles, Members of the guideline development and technical advisory groups are listed at the end of this report.
  1. a North of England Stable Angina Guideline Development Group
  1. Correspondence to: Dr Martin Eccles (project leader), Director of Primary Health Care Research, Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA.
  • Accepted 9 December 1995

The aim of this guideline is to provide recommendations to aid primary health care professionals in their management of patients with chronic stable angina due to coronary artery disease (not aortic stenosis or hypertrophic obstructive cardiomyopathy). It does not deal with unstable angina or myocardial infarction. It is a summary version of the full guideline,1 to which reference should be made for clarification or further information. The development group assumes that health care professionals will use general medical knowledge and clinical judgment in applying the general principles and specific recommendations in this document to the management of individual patients. Recommendations may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the practitioner in the light of available resources and circumstances presented by individual patients. Throughout this guideline categories of evidence (cited as I, II, and III) and the strength of recommendations (A, B, or C) are as described in the paper in the previous issue (23 March, p 760).

Scope of guideline

Aspects covered by this guideline are investigation, risk factor identification and management, drug treatment, and referral. All recommendations are for primary health care professionals and apply to adult patients attending general practice with angina.

Initial assessment

Comment—Assessment will be based on a clinical history and relevant examination. This guideline requires that the following should be known: precipitants of anginal attacks; smoking history; occupation; amount of exercise taken; drug history; weight; blood pressure.

Age limits

Comment—The group thought that a chronological age limit for investigation or referral was not appropriate. Functional status was thought to be more appropriate.

Precipitating factors RECOMMENDATION

  • Factors that precipitate angina should be inquired about and have their management discussed (C).

Investigation of angina RECOMMENDATION

Patients being investigated for angina should have the following investigations:

  • Haemoglobin measurement to identify anaemia (C)

  • Thyroid function measurements to identify thyroid disease (C) …

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