JAN: ORIGINAL RESEARCH Table 3 Healthcare utilization in each follow-up and group. 3-month follow-up GP visit Mean (SD) Median (Min–Max) Missing (%) Hospitalization, the number of cases Chest pain Angiogram PCI CABG Missing (%) 6-month follow-up GP visit Mean (SD) Median (Min–Max) Missing (%) Hospitalization, the number of cases Chest pain Angiogram PCI CABG Missing (%) LAMP (n = 70) 0Æ6 (1Æ7) 0 (0 – 10) 14 (22Æ9) 2 4 2 1 14 (22Æ9) 0Æ4 (1Æ0) 0 (0–6) 9 (15Æ7) 5 0 4 6 9 (15Æ7) Control (n = 72) 0Æ4 (1Æ1) 0 (0 – 4) 14 (19Æ4) 1 8 6 0 14 (19Æ4) 0Æ2 (0Æ7) 0 (0–3) 7 (9Æ7) 1 1 3 5 7 (9Æ7) PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft surgery. 1 ss0·9 nee0·8 itcv0·7 ffee0·6 tso0·5 fco0·4 lity0·3 i bab0·2 roP0·1 0 0 £20,000 £40,000 £60,000 £80,000 £100,000 Cost-effectiveness threshold Figure 3 Cost-effectiveness acceptability curve. and is therefore underpowered to show differences. The main reason for the lack of recruitment was the unexpectedly large number of people who did not meet inclusion criteria (871 of 1013 people attending clinic, the majority of whom were recorded as having non-cardiac chest pain). Whilst we were expecting that 50% would not be eligible, based on previous audit within the same RACPC, the additional numbers of 2012 Blackwell Publishing Ltd RCT of a lay-facilitated angina management programme ineligible patients reduced the pool of prospective partici- pants who could be recruited within the time frame. In addition, we have no details of the people who refused to participate, and so we cannot be certain that the study population fully reﬂects data of all people diagnosed with stable angina in RACPC. The study did recruit the same number of participants as in the original study, and does demonstrate some important differences between the two groups. This was a pragmatic randomized trial, conducted in the appropriate clinical settings, thus increasing the likelihood that its ﬁndings would apply to real practice. The quality of the study was high; randomization was by remote centre, data were collected by a nurse not involved in delivering the interventions and analysis was blind to group; however, participants could not be blinded their randomization status. A further strength is the high retention rate – with 87% completing follow-up at 6 months. In addition, the costs of both interventions have been estimated and analysed. Discussion of the results There was no difference in angina frequency between the groups. This difference is likely to be due to improvements in modern drug therapy, as the majority of participants did not have any angina at follow-up, which contrasts not only with the report of angina at follow-up in the original study (Lewin et al. 2002) but also with the studies reported in the meta- analysis of psychoeducational interventions.(McGillion et al. 2008a). However, as shown in Table 3, this lack of difference in angina frequency was not due to revascularization with percutaneous coronary intervention (N = 15) or coronary artery bypass graft surgery (N = 12), as relatively few participants received these interventions during the time frame. The lack of angina symptoms would also explain the lack of difference between the two groups in the Seattle Angina Questionnaire scales, which report the effect of angina on physical and psychological functioning. The LAMP had little extra effect on risk factors compared to advice from a nurse specialist; the exceptions being self-reported exercise at 3 months (not maintained to 6 months), and 6 month waist-to-hip ratio. The LAMP did have important effects on anxiety and misconceptions at both follow-up time points, and on depression at 6 months. LAMP is cost-effective. There are very few studies of angina self-management programmes, and therefore comparison with the literature is limited. In the original Angina Plan study (Lewin et al. 2002) there was an important effect on angina frequency which was not matched by lay-facilitation in this study. This difference is likely to be due to improvements in modern drug therapy, as 2275