JAN: ORIGINAL RESEARCH RCT of a lay-facilitated angina management programme analysis of psychoeducational programmes was unable to pool estimates of effects on psychological well-being due to heterogeneity (McGillion et al. 2008a). The burden of angina on patients is large; McGillion et al. (2008b) estimated that the total annual cost of living with angina was $19,209. As the cost per QALY for people receiving LAMP is much lower than the widely accepted value of £20–30,000 per QALY, which seems to inﬂuence NICE decision-making, it would seem that LAMP is cost-effective. A similar nurse-facilitated programme for people awaiting coronary artery bypass graft surgery also was found to be cost- effective (Furze et al. 2009). Other studies of angina rehabil- itation have produced no ﬁgures of cost utility, and therefore comparisons are not possible. The study by McGillion et al. did not assess cost utility of the CASMP, instead they assessed whether the programme reduced the ﬁnancial burden of people with stable angina, but there was no effect. People with stable angina need support to reduce their risk of further cardiac events, and this study adds to the evidence of nurse involvement in promoting self-management skills in their patients. It must be remembered that the lay workers in this study were managed by the community cardiac rehabil- itation nursing team who provided supervision and clinical support. In addition, the evidence for nurse-facilitated or supported self-management programmes has been developed in two different health services (Canada and the UK), suggesting that such programmes can be incorporated inter- nationally into the nursing care of people with stable angina, although further evidence is required to support this sugges- tion. Conclusion This study showed that, although the LAMP produced some beneﬁts when compared to advice from an Angina Nurse Specialist, particularly on anxiety and depression, the beneﬁts were not as profound as those previously produced by nurses facilitating the same programme. People may feel greater motivation to change their risk behaviour if they report these changes to a health professional. However, the LAMP was cost-effective, and it may be that a service where the programme is introduced by a nurse but follow-up is by lay facilitators would produce a greater impact on risk factors while maintaining the psychological support that is evident here. Such a skill-mix may produce similar outcomes to a fully nurse-facilitated programme but at less cost – however this would need testing for conﬁrmation of this hypothesis. NICE has recently conﬁrmed that there are very few studies of the efﬁcacy and cost utility of cardiac rehabilitation or self- management in people with stable angina (NICE 2011), and 2012 Blackwell Publishing Ltd therefore this study will add to that evidence base. In addition, there have been no trials of group vs. home-based cardiac rehabilitation in this patient group. This emphasizes the need for well-designed and fully powered, multi-centre studies of both self-management and of angina rehabilitation, a point endorsed in the NICE guideline (NICE 2011). Acknowledgements The authors acknowledge the trial support and data man- agement provided by York Clinical Trials Unit, and would like to thank all of the participants, lay workers and health professionals who contributed to the study. Conﬂict of interest No conﬂict of interest has been declared by the authors. Funding This project was supported by a British Heart Foundation Project Grant (number PG05/048). Included in this was the following salary support: GF (20%), HC (60%), HN (50%). NHS Bury provided the funding for HC and HN to extend the study for 6 months. Author contributions GF, RJPL and PE were responsible for the study conception and design, and supervised the study. HC, PN, RC and HN performed the data collection. VM and LHC performed the data analysis. GF, HC, VM, LHC and PE were responsible for the drafting of the manuscript. GF, HC, VM, LHC, RJPL, PN, RC, HN and PE made critical revisions to the article for important intellectual content. VM provided statistical expertise. GF, HC, RJPL and PE obtained funding. RC provided administrative, technical or material support. References Bakhai A., Ferrieres J., I n˜iguez A., Schmitt C., Sartral M., Belger M. & Zeymer U. (2011) International data on supportive therapies at 1 year in acute coronary syndrome patients undergoing PCI: results from the APTOR study. European Journal of Cardiovascular Prevention & Rehabilitation 18(3), 518–525. Balady G.J., Williams M.A., Ades P.A., Bittner V., Comoss P., Foody J.M., Franklin B., Sanderson B. & Southard D. (2007) Core com- ponents of cardiac rehabilitation/secondary prevention programs: 2007 update. Circulation 115(20), 2675–2682. British Association for Cardiac Rehabilitation (2007) Standards and Core Components for Cardiac Rehabilitation. BACR, London. 2277