Randomized controlled trial of a lay‐facilitated angina management programme

Abstract

AimsThis article reports a randomized controlled trial of lay-facilitated angina management (registered trial acronym: LAMP).BackgroundPreviously, a nurse-facilitated angina programme was shown to reduce angina while increasing physical activity, however most people with angina do not receive a cardiac rehabilitation or self-management programme. Lay people are increasingly being trained to facilitate self-management programmes.DesignA randomized controlled trial comparing a lay-facilitated angina management programme with routine care from an angina nurse specialist.MethodsParticipants with new stable angina were randomized to the angina management programme (intervention: 70 participants) or advice from an angina nurse specialist (control: 72 participants). Primary outcome was angina frequency at 6 months; secondary outcomes at 3 and 6 months included: risk factors, physical functioning, anxiety, depression, angina misconceptions and cost utility. Follow-up was complete in March 2009. Analysis was by intention-to-treat; blind to group allocation.ResultsThere was no important difference in angina frequency at 6 months. Secondary outcomes, assessed by either linear or logistic regression models, demonstrated important differences favouring the intervention group, at 3 months for: Anxiety, angina misconceptions and for exercise report; and at 6 months for: Anxiety; Depression; and angina misconceptions. The intervention was considered cost-effective.ConclusionThe angina management programme produced some superior benefits when compared to advice from a specialist nurse.

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

“…Of eight papers measuring health behavioural outcomes (Fernandes et al, 2009;Barlow et al, 2009;Hawkes et al, 2013;Muniz et al, 2010;Furze et al, 2012;Dalal et al, 2007;Zetta et al, 2011;Holmes-Rovner et al, 2008), two papers (Barlow et al, 2009;Dalal et al, 2007) did not report any difference between the two groups in terms of their health behavioural outcome measurement such as exercise capacity, smoking, BMI, BP, total cholesterol level, use of medication, coronary events and mortality. The other studies have indicated that self-M a n u s c r i p t 20 management interventions did produce improved outcomes in physical activity (Hawkes et al, 2013;Furze et al, 2012;Holmes-Rovner et al, 2008), BMI (Zetta, et al, 2011;Muniz et al, 2010), reported statins intake (Muniz et al, 2010), vegetable intake (Hawkes et al, 2013) and fruit intake (Fernandes et al, 2009) when compared to usual care.…”

“…(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).…”

“…one by the medical team (Muniz et al, 2010), psychologists (Petrie et al, 2002), the researcher (Wang et al, 2012), research assistant (Fernandes et al, 2009); and two by lay persons (Barlow et al, 2009;Furze et al, 2012 A c c e p t e d M a n u s c r i p t…”

“…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).…”