Abstract: . . .  its management of patients with angina . 9.29 The standards used for post MI management for the following elements will also apply to patients with angina : blood pressure, cholesterol lowering, use of aspirin or anticoagulant, smoking. a) All patients should have had their haemoglobin checked as part of their initial investigations. b) All patients should have had their plasma glucose measured to exclude diabetes as part of the initial investigations. c) All patients with stable angina should have had an exercise test, (or thallium scan). d) All patients with stable angina who require treatment, such as calcium antagonists, potassium channel blockers, nitrates, should be treated with a beta blocker unless contra indicated. e) All newly diagnosed patients with possible angina , under the age of ???, should be referred to a specialist clinic, according to locally agreed protocols. 9.30 From April 1 st 2001, to be monitored 31 st march 2002, the following standards: 1 a) Statin therapy should aim to lower total cholesterol below 5 mmol/l or to reduce total serum cholesterol by 20-25%, whichever would result in the lowest level of cholesterol. b) If the total pre-treatment cholesterol is > 6.21 mmol/l it must be reduced to below 5mmol/l. c) If the total pre-treatment . . .
. . .  of myocardial ischaemia (e.g., exercise ECG, thallium scan) Table 3 9.7 Criteria for immediate referral includes patients with unstable/rapidly progressing symptoms. Table 4 lists criteria for non-urgent referral. 9.8 Criteria for non-urgent referral of angina patients: a. Patients with angina secondary to a remediable cause b. Patients with unacceptable symptoms despite adequate therapy c. Patients in whom the diagnosis is in doubt d. Patients for whom the diagnosis affects their livelihood e . Ideally all patients with newly diagnosed angina should be assessed to determine the severity of their myocardial ischaemia and any subsequent potential for revascularisation procedures (a local protocol will have to be developed by the Heart Forum to determine local procedures) Table 4 Standards for the Diagnosis and Management of Angina 9.9 The practice must be able to identify all patients who have been diagnosed as having angina . 9.10 All patients who have been diagnosed as having angina should be provided with factual information, in the form of leaflets, booklets etc, with additional contacts (support groups, etc) where appropriate. The information provided should be sufficient to enable the patient and/or carer to participate in decisions about their care. Page 3  . . .
--3000,2,750,3165,15950