Commentary

Angina affects 7.7% of the population over the age of 65.¹ Advances in secondary prevention of coronary heart disease with drug treatment and increasing use of coronary revascularisation have overshadowed other methods of managing angina patients. Anxiety, depression, and reduced quality of life are associated with angina and predict outcome independently of coronary angiographic findings. Moreover, the disability from angina is not a simple function of the degree of myocardial ischaemia: patients with relatively mild ischaemia can be severely disabled by their symptoms.² Pharmacological and surgical methods do not address these problems. Cognitive behavioural techniques have been used successfully to manage symptoms from a wide range of chronic conditions.³. Previous studies have shown that these techniques, applied in the context of a home based self help rehabilitation programme after a coronary event, can improve psychological morbidity and reduce health service use.⁴

The study by Lewin et al targets patients recently diagnosed with angina in primary care. A relatively short consultation with a specially trained nurse, provision of written material, and a relaxation tape followed by periodic telephone follow up, is a feasible intervention for internal medicine, family, or general practices. This study is small and probably underpowered, the change in mental health outcomes was modest, patients were followed up for only 6 months, and 1 nurse carried out all the interventions. Because of these limitations, it is premature to recommend routine implementation of the intervention. Yet the positive change in many of the outcome measures is an impetus for further research on brief interventions with a cognitive behavioural framework. This study reminds us again of the importance of addressing patients‘ educational and emotional needs in managing angina and other chronic conditions.