Diagnose stable angina according to NICE guidelines on recent-onset chest pain of suspected cardiac origin, and manage it based on the best available evidence NICE CG126.
Provide clear information and support to the person, including factors that provoke angina (such as exertion, emotional stress, cold exposure, heavy meals), and discuss its long-term course and management NICE CG126,NICE CKS.
Encourage questions, address misconceptions, and involve family or carers when relevant NICE CG126,NICE CKS.
Advise seeking professional help if there is a sudden worsening of angina symptoms NICE CG126.
Discuss the purpose, risks, and benefits of treatment, including lifestyle advice on exercise, smoking cessation, diet, and weight control NICE CG126.
Offer a short-acting nitrate for immediate relief and prevention of angina episodes, instructing on its use and advising to call emergency services if pain persists after two doses NICE CG126,NICE CKS.
Consider starting or continuing aspirin 75 mg daily for secondary prevention, taking into account bleeding risk NICE CG126.
Consider ACE inhibitors for people with diabetes and offer or continue them for other conditions like hypertension or heart failure NICE CG126.
Offer statin treatment in line with NICE lipid modification guidelines NICE CG126.
Offer treatment for high blood pressure according to NICE hypertension guidelines NICE CG126.
Do not offer vitamin or fish oil supplements for stable angina, as there is no evidence of benefit NICE CG126.
Use optimal drug treatment, typically one or two anti-anginal drugs plus secondary prevention medications, aiming to prevent angina episodes and cardiovascular events NICE CG126.
Review response and side effects 2–4 weeks after starting or changing treatment, titrating doses as needed NICE CG126.
Refer for revascularization if symptoms are poorly controlled despite maximum tolerated doses of two drugs or if there is evidence of extensive ischemia NICE CG126.