Who's using the Angina Plan?

Margaret Rodaway: The Devon Experience

The population served by South Devon Healthcare NHS Trust covers 3 Primary Care Trust's (PCT's). One PCT has purchased copies of the Angina Plan. My experiences to date of using the Angina Plan with patients have far exceeded expectations of patient benefit. Providing a comprehensive individualised programme, which targets those within secondary care diagnosed with angina, ensures a seamless return to primary care under the care of their GP/Practice Nurse.

Patients are identified in secondary care following angiography where medical management is the optimum course of treatment. While Cardiac Rehabilitation (CR) is provided to those post myocardial infarction and cardiac surgery, at present there is no provision for patients with a diagnosis of angina. The Angina Plan is able to address the CR needs of this cohort. I have chosen those patients who have symptoms of stable angina i.e. exertional chest pain relieved with the use of GTN or those on optimum therapy but with reduced activity levels. The satisfaction of guiding each patient as they make positive adjustments to their lifestyle which results in them regaining improved quality of life is both challenging and rewarding. The problems encountered are minimal on reflection of the successes achieved. The Advice and Relaxation cassette tapes have posed a problem, as many people now only have CD players.

I have found that angina symptoms are virtually diminished in all patients as they progress through the Angina Plan. Family members have been sceptical about how the programme can alter their relative's quality of life and are surprised at the positive results. Many patients set small goals initially, but soon regain confidence and achieve a lot more through knowledge gained and self-determination. Once patients are successful in one aspect of their CHD risk factor reduction I feel the rest follows as a natural progression to their self-management. All are surprised when angina misconceptions are addressed. It is these that truly hold the patient back in achieving optimum quality of life. Relaxation skills are another hurdle many patients are reluctant to develop, but when confidence is gained everything appears to slot into place. Phase 4 cardiac rehab, healthy walking schemes and exercise on referral are all a natural development for this group. Addressing modifiable CHD risk factors reinforces that lifestyle change is for a lifetime.

Reproduced from BACR Newsletter 2004;4(3):7-9)

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