The problem: Britain lags behind many developed countries in performing coronary artery bypass grafts (CABGs), and other techniques which help people suffering from angina. Some people who might benefit are being denied these treatments while others may get them inappropriately.
What is angina? Angina is a dull pain or pressure in the chest, shoulder, arm or jaw. It is a sign that the heart is under stress, usually due to furred-up arteries. People with angina have an increased risk of heart attack.
What treatments are available? There are two aims in treating angina: to relieve pain and reduce the risk of a heart attack. Most angina is treated by GPs prescribing drugs which only control symptoms. Large-scale studies show these drugs, like nitrates and beta-blockers, are the best approach for people with less-advanced heart disease. Angina sufferers should also take aspirin which significantly reduces their risk of heart attack.
What if the drugs don't work?There are two options: coronary artery bypass grafting or angioplasty. In CABG, (pronounced 'cabbage') surgeons bypass the blockage with a length of artery or vein usually taken from the patient's leg. This is major surgery and it involves a long recuperation. Alternatively angioplasty involves widening the artery by inflating a tiny balloon in it, and is done under local anaesthetic. For people at higher risk of heart attack, these procedures offer the best chance of relieving angina.
Which is best? Trials show no difference between the two procedures in terms of long-term survival. Angina is more likely to recur after angioplasty than after CABG, but because angioplasty is much less invasive and can be repeated, it is often tried first.
To try and reduce re-furring, surgeons now often insert a stent, a small metal tube, to support the re-widened artery. However, the jury is still out on whether these help prevent blockage returning in the long term.
In advanced heart disease when all three of the heart's arteries are clogged, large studies suggest CABG is the best option, since in these cases the risks involved in major surgery are outweighed by the benefits.
Will I always be offered these choices? Recent studies suggest that women, people from ethnic minorities and people in deprived areas are less likely to be sent for tests or treatment if their angina pain continues. So be sure to ask for the full range of options.