An holistic approach to angina

Chronic angina that is refractory to medication and conventional revascularisation is a small but growing clinical problem. Many patients and their carers are suffering physically, psychologically, socially and spiritually from chronic refractory angina but continue to be managed poorly by healthcare professionals who fixate on the disease centred model approach to angina. For those patients in whom a diagnosis of chronic stable angina has been made by a cardiologist and cardiothoracic surgeon and in whom revascularisation is deemed impossible or too risky, we suggest that the palliative patient-centred model approach be adopted allowing patients to experience optimal quality of life. The UK refractory angina consensus guideline sets out a logical order in which these therapies should be trialled based on the available evidence.