“Part of the problem is that patients may have angina when they walk up a hill, so they avoid walking up hills. When you ask them how they are doing, they may say they are doing fine. You need to ask the next question, which is, ‘How has angina changed your lifestyle?’,” Dr. Jerome told Clinical Pain Advisor.

The findings suggest that primary care providers may benefit from using a short-form questionnaire, known as the Stable Angina Record (STAR), to facilitate communication and identify disease management issues. The simple checklist can be filled out in the waiting room and measures breakthrough symptoms, response to medication, and compliance with lifestyle changes.

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Achieving Optimal Medical Management

The latest guidelines from the European Society of Cardiology suggest that angina should be initially treated with beta-blockers and/or rate-limiting calcium channel blockers. Second-line treatment options include long-acting nitrates and agents such as ivabradine and nicorandil. All these medications have side effects and contraindications that need to be considered on an individual basis, but there are enough options for most patients to be adequately controlled, the authors write.

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“We use guidelines from the American College of Cardiology, but the guidelines are similar. There are plenty of good guidelines — the key for providers is to read them and follow them,” Dr. Jerome emphasized

“Drugs [such as] statins and aspirin are important for actually reducing the risk of heart attack or stroke; other medications may just reduce symptoms,” Dr. Jerome added.

“Two ways to improve management and quality of life in [angina] patients are to use drugs with less side effects, and to use drugs that actually reduce angina attacks,” Dr. Manolis concurred.

The Role of Revascularization

Although coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) may be considered, there is no evidence that revascularization is superior to optimal medical management, the author write.