Non-Pharmacological Interventions in Refractory Angina

Abstract

Refractory angina (RA) is defined by intractable cardiac chest pain despite standard medical therapy and revascularisation. Symptoms
are associated with significant morbidity and compromised quality of life (QoL). Various methods of interventional pain
management can be considered for the complex care of these cohorts. This review explores postulated mechanisms and evidence
base underpinning therapeutic strategies such as cognitive behavioural therapy (CBT), cardiac rehabilitation, stellate ganglion blockade
(SGB), enhanced external counterpulsation (EECP) and coronary sinus reducer (CSR) implantation. Use of these modalities is
dependent on the local provision, but suitability is best assessed by specialist RA services using an individualised, multidisciplinary
framework.