Randomized controlled trial of a lay-facilitated angina management programme

Abstract

Aims: This article reports a randomized controlled trial of lay-facilitated angina management (registered trial acronym: LAMP).

Background: Previously, 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.

Design: A randomized controlled trial comparing a lay-facilitated angina management programme with routine care from an angina nurse specialist.

Methods: Participants 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.

Results: There 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.

Conclusion: The angina management programme produced some superior benefits when compared to advice from a specialist nurse.

Figure 1

CONSORT diagram showing participant flow through the study.

Figure 2

Angina Plan facilitation first interview flow chart.

Figure 3

Cost-effectiveness acceptability curve.