When should I consider referring a patient with stable angina for further investigation or specialist review?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Consider referring a patient with stable angina for further investigation or specialist review if:

  • The angina seems to be progressing rapidly despite increasing medical treatment, and there is evidence of extensive ischaemia on ECG, persistent angina despite optimal drug treatment (maximum doses of two drugs), and lifestyle interventions .
  • The person has left main stem disease or proximal three-vessel disease, and their symptoms are satisfactorily controlled with optimal medication, but they may benefit from revascularization after discussing prognosis, risks, and benefits with the patient .
  • The stable angina has not responded to drug treatment and/or revascularisation, warranting comprehensive re-evaluation and consideration of further treatment options .
  • There is suspicion of unstable angina, such as pain at rest, pain on minimal exertion, or new/worsening symptoms, which requires urgent hospital referral .

Additionally, if the person has ongoing symptoms despite optimal treatment, or if there are signs of complications or high-risk features, referral should be considered .

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