G. Furze et al. Richard Carty MSc RN Angina Nurse Specialist Pennine Acute NHS Trust, UK Heather Norris BA RN Community Cardiac Nurse NHS Bury, UK Nicky Patel MA RN Manager Cardiac Services NHS Bury, UK Peter Elton MBChB MFCM Director of Public Health NHS Bury, UK Introduction Stable angina is deﬁned as pain or discomfort in the chest, jaw or shoulder that is evoked by exercise or emotion and is relieved by rest or nitroglycerin (Fox et al. 2006). It is considered stable when there is no increase in frequency or severity of symptoms (NICE 2011). Although it can be precipitated by a number of conditions, it is accepted that stable angina is a symptom of coronary heart disease (CHD). It is a chronic condition that affects over 2 million people in the UK (Scarborough et al. 2010), over six million in the USA (Roger et al. 2010), and has profound effects on functioning and quality of life (Lyons et al. 1994, Brorsson et al. 2002, MacDermott 2002, Spertus et al. 2002). Current guidelines for the treatment of stable CHD (including angina) emphasize the importance of encouraging people with heart disease to undertake secondary prevention programmes and to improve self management of their condi- tion (Balady et al. 2007, NICE 2011). Cardiac rehabilitation is a comprehensive programme aimed at improving secondary prevention, physical and psychological functioning and quality of life, and which has been found in meta-analyses to reduce cardiac mortality after myocardial infarction (MI) by approx- imately 26%. Home-based versions of cardiac rehabilitation are as effective as centre-based for people post myocardial infarction or revascularization (Jolly et al. 2009, Dalal et al. 2010), and offering a choice of format can increase uptake among people with heart disease (Dalal et al. 2007). However, cardiac rehabilitation is often not routinely offered to people with stable angina; in the 2009 UK national audit of cardiac rehabilitation, 20% of all programmes actively excluded stable angina, and angina referrals accounted for only 4% of the 90,000 patients included in the audit (Lewin et al. 2010). Referral to and uptake of cardiac rehabilitation is also low in Europe, the USA, Canada and Australia (Cortes & Arthur 2268 2006, Wenger 2008, Bakhai et al. 2011) with few data about stable angina, as it is not usually included in these audits. Background Angina is a distressing condition; although its impact varies from person to person, over 50% of people with angina are limited in their activities, which can lead to premature retirement (Fox et al. 2006). A meta-analysis of seven trials of psychoeducational interventions for people with stable angina reported that such programmes reduced symptoms, improved quality of life and physical limitations (McGillion et al. 2008a). It has also been suggested that a number of common misconceptions about angina are associated with reduced physical and psychological functioning and quality of life in people with angina (Furze et al. 2003, 2005). Guidelines recommend that misconceptions about living with angina are dispelled [Scottish Intercollegiate Guideline Net- work 2007, NICE 2011]. According to a recent systematic review, programmes based on cognitive-behavioural princi- ples may be effective in reducing these misconceptions (Goulding et al. 2010). In a previous randomized controlled trial (RCT), it was demonstrated that a cognitive-behavioural, nurse-facilitated, angina self-management and rehabilitation programme (the Angina Plan) was signiﬁcantly better than routine nurse education in reducing angina report and improving physical and psychological outcomes at 6-month follow-up (Lewin et al. 2002). A more recent study of the Angina Plan among people hospitalized with angina reported similar ﬁndings (Zetta et al. 2011). Since the publication of the results, over 900 professionals, the majority nurses, have been trained to deliver the Angina Plan, and over 20,000 patients have received the programme. However, as there are approxi- mately 28,000 new cases of angina diagnosed in the UK each year (Scarborough et al. 2010), there are still many patients with stable angina who do not receive self-management education or rehabilitation, often due to lack of resources. The Angina Plan meets the UK standards (British Association for Cardiac Rehabilitation 2007) to be considered a form of home-based cardiac rehabilitation. The recent NICE guide- line for the management of stable angina stated that ‘components of the Angina Plan were beneﬁcial to people with stable angina but the evidence was not adequate to recommend the programme based on a small study sample’ (NICE 2011, p. 375). Over the past decade there has been increasing report of self-management programmes delivered by peers or lay workers for people with long-term conditions (for example the studies by Lorig et al. 1994, Lorig et al. 1999, 2001a, 2012 Blackwell Publishing Ltd