RCT comparing a selfhelp cognitive behavioural programme, the Angina Plan, with standard care for an

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• RCT comparing a self-help cognitive behavioural
  programme, the Angina Plan, with standard care
  for angina patients admitted to hospital
• Study funded by CSO
• Zetta S,
• Jones M, Smith K, Sullivan F.

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Background

• Scotland has one of the highest incidence of CHD
  in the world1
• Angina is associated with increased psychological
  distress and decreased quality of life
• 6-month evaluation of patients with angina
  discharged from Ninewells showed2
• 58 suffer from angina
• 42 reported moderate to severe anxiety
• 23 reported moderate depression
• Minimal reduction of their risk factors
• Angina Plan self-help cognitive behavioural
  programme for newly diagnosed angina patients3

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Aim

• To compare a short, self-help programme based on
  the principles of cognitive behavioural therapy,
  the Angina Plan, against standard care in
  patients admitted with angina to a secondary care
  setting

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Study Design
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Group 1 Angina Plan

• Patient-held work-book and audiotaped
  relaxation information programme
• 30-40 min structured interview by the trained
  Angina Plan facilitator
• Partners involved where possible
• Correction of misconceptions using CBT
• Identification of personal risk factors
• Goal setting and pacing to negotiate gradual
  return to activities and introduce lifestyle
  changes

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Group 1 Angina Plan

• 20 min daily relaxation using audiotape
• encouraged to initiate an exercise programme
  based on daily walking
• 5-10min follow-up phone calls by the AP nurses at
  the end of weeks 1,4,8 and 12
• review of goals and establishment of new goals

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Group 2 Standard Care

• Care delivered by ward nursing staff
• Depended on skill mix and workload
• No set protocol were used
• Aim to assess individuals risks factor and
  provide verbal information, written educational
  material and support

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Measures Used

• Demographic and clinical data
• Mood (HADS)1 ?
• Quality of Life (SF-362 and SEIQoL-DW3)
• Symptoms (SAQ4 and CLASP5)
• Cardiac Misconceptions (YABQ6) ?
• Individual Differences (Motivation to change7 and
  FAM8)
• ?measured also in partners

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Measures-2

• Risk Factors
• blood pressure
• BMI (kg/m2)
• cholesterol
• diet
• smoking
• exercise habits
• Health Service Utilisation

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Results
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YABQ
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Risk Factors-BMI
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Self-reported Exercise
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Seattle Angina Questionnaire
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C.L.A.S.P.
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SF-36
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Sensitivity analysis-1

• Excluded HADS depressiongt11 at baseline
• N13 (6)
• Major life events

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Sensitivity analysis-excluding patients that went
for CABG or PCI
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Partners
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Conclusion

• Improvements in knowledge and reduction of
  misconceptions of cardiac disease and
  improvements in some aspects of patients risk
  factor profile.
• Practical method of initiating CR in a secondary
  care setting for patients with new and
  established CHD
• The impact of CR interventions on partners merits
  further investigation