A paper published in the British Journal of General Practice (See Summary below) shows that patients on the York Angina Plan, compared to those receiving a conventional educational session, reported a 40% reduction in the number of episodes of angina per week (a reduction of three from the baseline mean of seven attacks). This was despite the fact that they were more active. They also showed a lower level of anxiety and depression six months later (1).

The research team which included Roger Boyle, the Government Heart Tzar, was led by Professor Bob Lewin, Professor of Rehabilitation at the University of York. "Studies have shown that anxious or depressed cardiac patients accrue four times the hospitalisation costs of non-distressed patients (2) and that medical costs are 41% higher in depressed versus non-depressed cardiac patients (3)

There are approximately 1.5 million patients with angina in the UK (4,5) many of whom report a poor quality of life, (6,’7,8) including raised levels of anxiety and depression as a result of their condition (9) The recent National Service Framework for Coronary Heart Disease has called for rehabilitation to be made available to all patients with heart disease (10) but at present cardiac rehabilitation is mostly provided in secondary care, whereas the majority of angina patients are being managed in primary care.

The York Angina Plan is designed for use in primary care immediately following a diagnosis of angina. It consists of a patient-held workbook, diary and an audio taped relaxation programme, which is introduced to the patient during a 30-40 minute structured interview by, in most cases, the practice nurse. Any misconceptions patients may have about angina are identified and discussed to correct their understanding of the illness and to explain how these beliefs can lead to unnecessary rest and withdrawal from normal life. (8)

The practice nurse then works with the patient to identify their personal risk factors for coronary heart disease and to identify realistic ways of reducing these such as increasing activity levels and introducing lifestyle changes, such as improvement in diet and capacity for exercise. The York Angina Plan also includes information on what to do in the event of a heart attack.

The York Angina Plan is funded by a research grant from Pfizer Limited as part of the Cardiomark initiative.

References:

1. Lewin RJP, Furze G, Robinson J, et al. A randomised controlled trial comparing a cognitive-behavioural angina management programme with an educational session in patients with newly diagnosed angina. To be published on 25 January 2002 in British Journal of General Practice

2. Allison T, Williams T, Patten C, et al. Medical and economic costs of psychologic distress in patients with coronary artery disease. Mayo Clinic Proceedings 1995; 70: 734-742

3. Frasure-Smith N, Lesperance F, Gravel G, et al. Depression and health care costs during the first year following MI. Journal of Psychosomatic Research, 2000; 48: 471-478

5. Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office. London

6. Gandj our A, Lauterbach KW. Review of quality-of-life evaluations in patients with angina pectoris. Pharmacoeconomics 1999; 16: 141-152

7. Lyons RA, Lo SV, Littlepage BNC. Comparative health status of patients with 11 common illnesses in Wales. Journal of Epidemiology and Community Health 1994; 48: 3 88-390

8. Lewin RJP. Improving quality of life in patients with angina. Heart 1999; 82: 654-655

9. Charmer KS, Papouchado M, James MA, Rees JR. Anxiety and depression in patients with chest pain referred for exercise testing. The Lancet 1985; ii: 820-823

Aim: To evaluate the effect of a cognitive behavioural disease management programme, the Angina Plan, on psychological adjustment in patients newly diagnosed with angina pectoris.

Design of study: Randomised controlled trial.

Setting Patients from GP practices in a Northern UK city (York) between April 1999 and May 2000.

Method: Recruited patients were randomised to receive the Angina Plan or to a routine, practice nurse-led secondary prevention educational session.

Conclusion: The Angina Plan appears to improve the psychological, symptomatic, and functional status of patients newly diagnosed with angina.