G. Furze et al. What is already known about this topic • Guidelines recommend that people with stable angina are supported to improve their condition self- management and secondary prevention of heart disease, but only a minority are referred to such programmes. • Increasingly, self-management support provided by lay workers is employed among people with long-term conditions. • A randomized controlled trial of a nurse-facilitated angina management programme reported important improvements in report of angina and quality of life when compared to routine nurse advice and education. What this paper adds • Lay workers can be trained to facilitate a lay angina management programme, under the supervision of community cardiac rehabilitation nurses. • Compared to a single advice and education interview from an angina nurse specialist, a 12-week lay- facilitated angina management programme had important effects on reports of exercise and psychological functioning, but no effect on report of angina and is considered cost-effective. • This study gives further evidence that lay-delivered self- management support in long-term conditions produces modest beneﬁts. Implications for practice and/or policy • Where a full nurse-led angina management programme is not possible due to resource issues, it may be possible that a combined nurse/lay service will produce the necessary clinical improvements in secondary prevention, while providing the psychological support shown in this study. the majority of patients were angina-free at 6-month follow- up. However, it is also possible that the populations differed between the two studies. For this study, patients were recruited following diagnosis of stable angina within RACPC. This means that their symptom onset was often <1 month. As there were very few RACPCs in 2000, the original study recruited people from primary care, where the most efﬁcient method of identiﬁcation (given known problems with diag- nostic codes) was prescription of short-acting nitrates. All patients had their symptoms for <1 year, but their use of nitrates suggests that they were still suffering episodes of 2276 chest pain, and so may have been more refractory than the participants in the current study. The effects on secondary outcomes in this study were also not as profound as those in the original study. There was an increase in activity among the LAMP group at 3 months (when lay facilitator support ceased) which was not maintained to 6 months, whereas improvements in physical functioning were found at 6 months in both previous studies (Lewin et al. 2002, Zetta et al. 2011). It may be that facilitation of the Angina Plan by a nurse produces longer lasting change in health behaviour for exercise than facilita- tion by a lay person. McGillion et al. (2008c) developed a nurse-facilitated, group-based angina self-management pro- gramme derived from the Chronic Disease Self-management Programme developed by Kate Lorig at Stanford University (Lorig et al. 2001b) and tested this in a RCT with 130 participants. The Chronic Angina Self-Management Programme (CASMP) was compared to usual care (waiting list) and followed up for 3 months, It was found to reduce angina frequency and improve physical functioning but had no effect on psychological functioning as measured by the Short-Form 36 questionnaire (McGillion et al. 2008c). The combined evidence from the three studies of nurse-facilitated self-management programmes (Lewin et al. 2002, McGillion et al. 2008c, Zetta et al. 2011) may suggest greater effect on outcome of nurse delivered care, however, this would need to be tested in a randomized trial. As lay Health Trainers are increasingly delivering health behaviour change advice to people with long-term conditions in the UK, the discrepancy in the uptake of exercise following lay or nurse facilitation requires further investigation in studies directly comparing the two methods of delivery of self-management pro- grammes. In addition, follow-up needs to be longer than 3 or 6 months, as requested by NICE (2011). With the exception of waist-to-hip ratio, there were no other important effects on risk factors in this study, whereas Zetta et al. study reported a difference in BMI (Zetta et al. 2011). However, this difference in outcomes may reﬂect the lack of power of the present study, as there was a greater reduction in BMI among the LAMP participants than among those in the Angina Plan group in the Zetta et al. study. Participants in the LAMP reported signiﬁcantly less anxiety at both time points and less depression at 6 months, which compares with the ﬁndings of the original study, but not that of Zetta et al.(2011) (which found no effect on anxiety and depression). However the participants in the Zetta et al. study had very low levels of anxiety and depression at baseline (mean scores of <3 for both HADS Anxiety and HADS Depression) and therefore it would be difﬁcult to achieve important reductions in these scores. The meta- 2012 Blackwell Publishing Ltd