Abstract: . . .  two medications given together, there is usually little to be gained from the addition of a third anti-anginal medication. Refractory angina 9.18 Many people whose symptoms are not well controlled by medication can have their symptoms improved by revascularisation. Unfortunately, not everyone is suitable for revascularisation - some people are too ill and some people do not have operable narrowings of their coronary arteries. 9.19 Although there is little high quality evidence to guide practice, there is a growing consensus among experts in the field on what constitutes best management of refractory angina . This consensus is reflected in a provisional guideline that is expected to be finalised in 2000. It is hoped that further research will be commissioned to improve understanding about how best to help these people. Page 4 East Kent Health Authority Clinical Effectiveness Primary Care (PRICCE) Guidelines 41 15 April 2003 Exercise testing 9.20 Exercise testing provides prognostic as well as diagnostic information. However, exercise testing may not be helpful where: a) Symptoms are uncontrolled on optimal medical therapy b) There is uncertainty about the diagnosis of angina among people in whom the clinical diagnosis of CHD is uncertain and who have a high proportion of false positive results c) Someone is physically incapable of undertaking the test (alternative tests are available e.g., thallium scanning). Women 9.21 Most tests (e.g., exercise ECG) for estimating the severity of myocardial ischaemia are less accurate in women than they are in men. The reasons for this are not well understood but mean that special consideration should be given to women who present with symptoms suggestive of angina . Diabetes 9.22 Diabetes increases someone's risk of developing and dying from heart disease two to five fold. People with angina who also have diabetes will benefit from particularly meticulous attention to their modifiable risk factors. Minority Ethnic Groups 9.23 People's risk of developing CHD also varies with their ethnicity. For example, CHD death rates are about 25 to 50% lower among people of Afro-Caribbean descent than among UK whites. By contrast, some people of South Asian descent have a CHD risk that is about 40% greater than among whites in the UK. Differences in people's exposure to recognised risk factors may account for much of these differences. 9.24 Primary care teams and hospitals should take people's ethnicity into account when advising individual patients, and be aware which of their patients are likely to be at relatively higher or lower risk because of their ethnicity. 9.25 All NHS . . .
--3000,1,1500,3094,15950