Evaluating the Angina Plan in Patients Admitted to Hospital with Angina: A Randomized Controlled Trial

Abstract

The aim of this trial was to evaluate the Angina Plan (AP), a cognitive‐behavioral nurse‐facilitated self‐help intervention against standard care (SC). A randomized controlled trial of 218 patients hospitalized with angina assessed participants predischarge and 6 months later. Data were collected during a structured interview using validated questionnaires, self‐report, and physiological measurement to assess between group changes in mood, knowledge and misconceptions, cardiovascular risk, symptoms, quality of life, and health service utilization. The intention‐to‐treat (ITT) analysis found no reliable effects on anxiety and depression at 6 months. AP participants reported increased knowledge, less misconceptions, reduced body mass index (BMI), an increase in self‐reported exercise, less functional limitation, and improvements in general health perceptions and social and leisure activities compared to those receiving SC. Sensitivity analysis excluding participants with high baseline depression revealed a statistical significant reduction in depression levels in AP compared to the SC participants. Analysis excluding participants receiving cardiac surgery or angioplasty removed the ITT effects on physical limitation, self‐reported exercise and general health perceptions and the improvements seen in social and leisure activities, while adaptive effects on knowledge, misconceptions and BMI remained and between‐group changes in depression approached significance. Initiating the AP in a secondary care setting for patients with new and existing angina produces similar benefits to those reported in newly diagnosed primary care patients. Further evaluation is required to examine the extent of observed effects in the longer term.

The effectiveness and experience of self-management following acute coronary syndrome: A review of the literature

“…(Table 1). Nine were carried out in the UK (Lewin et al, 2002;Barlow et al, 2009;Lacey et al, 2004;Furze et al, 2012;Dalal et al, 2007; A c c e p t e d M a n u s c r i p t 14 Taylor et al, 2007;O'Rourke and Hampson, 1999;Zetta et al, 2011;Linden 1995), four in Australia (Fernandes et al, 2009;Hawkes et al, 2013;O'Neil et al, 2014;Turkstra et al, 2013) and one in each of the following countries: USA (Holmes-Rovner et al, 2008), Canada (Aish and Isenberg, 1996), Spain (Muniz et al, 2010), New Zealand (Petri et al, 2002, Philippine (Ocampo-Balabagno, 1999) and China (Wang et al, 2012).…”

“…In some papers, the conceptual frameworks were briefly described such as social cognitive theory (Hawkes et al, 2013;Turkstra et al, 2013, O'Neil et al, 2014, transtheoretical model of behaviour change (Fernandes et al, 2009), cognitive-behavioural therapy (Lewin et al, 2002;Zetta et al, 2011), Orem's self-care deficit theory of nursing and theory of self-efficacy (Aish and Isenberg, 1996), social learning theory and self-regulation model (O'Rourke and…”

“…The angina plan (Lewin et al, 2002;Zetta et al, 2011) was based on theoretical principles of cognitive behavioural therapy. The aim of cognitive behavioural therapy is to allow people to take control of their own problems, manage feelings and behaviours, and deal with future problems in an adaptive way.…”

“…Of these, five suggested that self-management interventions were effective in reducing anxiety (Wang et al, 2012;Lewin et al, 2002;Lacey et al, 2004;Furze et al, 2012;O'Neil et al, 2014), whereas five did not demonstrate difference in anxiety scores between the intervention and control groups (Barlow et al, 2009;Dalal et al, 2007;O'Rourke and Hampson, 1999;Zetta et al, 2011;Linden, 1995). Four papers found a positive effect of self-management interventions on symptoms of depression (Lewin et al, 2002;Lacey et al, 2004;Furze et al, 2012;O'Rourke and Hampson, 1999) and six did not (Wang et al, 2012;Barlow et al, 2009;Zetta et al, 2011;O'Neil et al, 2014;Linden, 1995).…”

“…Four papers reported the positive effects of self-management interventions on at A c c e p t e d M a n u s c r i p t 19 least one domain of quality-of-life measure (Wang et al, 2012;Hawkes et al, 2013;Zetta et al, 2011;Lewin et al, 2002), while the others did not demonstrate any difference between the two groups (Barlow et al, 2009;Furze et al, 2012;Lacey et al, 2004;Dalal et al, 2007;Holmes-Rovner et al, 2008).…”