The number of people in Scotland dying from heart attack has fallen sharply over the last 20 years, but it’s estimated that 18% of men aged 65–74 and 32% of men aged 75 and over are living with ischaemic heart disease (heart attack or angina), while prevalence in women in these age groups stands at 9% and 20%, respectively.

A diagnosis of angina can have a significant impact on a patient’s level of functioning and quality of life, but a new updated guideline for the diagnosis and management of stable angina aims to improve diagnosis and treatment for patients.

Angina is chest pain caused by reduced blood flow to the heart muscles. It’s not usually life threatening, but it can be a warning sign that a patient could be at risk of a heart attack or stroke. Therefore, management of the condition is crucial to help save more lives.

In identifying and treating stable angina there are clear challenges for healthcare professionals:

  • correctly identifying patients that have chest pain related to cardiovascular disease (CAD) and distinguishing it from chest pain due to other causes
  • identifying and ensuring patients with CAD receive appropriate treatments
  • ensuring those patients with CAD undergoing non-cardiac surgery receive the correct treatments to protect their heart during surgery.

The updated guideline is produced by SIGN, a part of Healthcare Improvement Scotland which has been producing internationally-recognised clinical guidelines for 25 years. The guideline updates SIGN guideline 96 on management of stable angina which was published in 2007, and it reflects the most recent evidence, and covers crucial areas such as diagnosis and assessment, pharmacological management, interventional cardiology and cardiac surgery, as well as psychological health interventions.

The use of the guideline by clinicians is crucial to ensure that more lives are saved. For this reason, SIGN have issued electronic versions of the full guideline to all NHS boards, versions will be available as iPhone, iPad and Android apps, and, to help empower patients to play a role in their own care, patient versions of the guideline for adults, parents and carers and children, will be available later this year. Moreover, this guideline is one of six guidelines for coronary heart disease produced by SIGN, all of which are being updated over the course of 2016–2018.

As Chair of the group which worked to develop the guideline, I’m proud of this piece of work and would urge clinicians to make full use of the guideline to ensure that patients receive the best and most appropriate care to manage their condition and help people with stable angina live full and healthy lives.


Dr Cruden is a Consultant Cardiologist based in Edinburgh with expertise in percutaneous coronary intervention, transcatheter aortic valve implantation and cardiac devices. He is Clinical Director for Cardiac Services in NHS Lothian and chairs the guideline development group updating SIGN 96 (Management of Stable Angina).