Management of Stable Ischemic Heart Disease: Summary of a Clinical Practice Guideline From the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons

Perspective:

The following are 10 points to remember about this guideline summary:

1. The goals of treating patients with stable ischemic heart disease (IHD) are to prevent premature cardiovascular death and complications of stable IHD, including nonfatal acute myocardial infarction (MI) and heart failure, and to maintain or restore a quality of life that is satisfactory to the patient, while eliminating avoidable adverse effects of tests and treatments, preventing hospital admissions, and eliminating unnecessary tests and treatments.

2. An explanation of medication management and cardiovascular risk reduction strategies in a manner that respects the patient’s level of understanding, reading comprehension, and ethnicity is recommended.

3. Patients with stable IHD should be educated regarding lifestyle elements that may influence prognosis such as weight control, blood pressure management, lipid management, etc.

4. In addition to therapeutic lifestyle changes, a moderate or high dose of a statin therapy should be prescribed in the absence of contraindications or documented adverse effects.

5. Aspirin, 75-162 mg daily, should be continued indefinitely in the absence of contraindications in patients with stable IHD.

6. Beta-blocker therapy should be initiated and continued for 3 years in all patients with normal left ventricular (LV) function following MI or acute coronary syndromes. Beta-blockers should also be prescribed as initial therapy for relief of symptoms in patients with stable IHD.

7. Angiotensin-converting enzyme inhibitors should be prescribed in all patients with stable IHD who also have hypertension, diabetes, LV systolic dysfunction (ejection fraction ≤40%), and/or chronic kidney disease, unless contraindicated.

8. A shared decision-making approach should be utilized when making decisions about revascularization in patients with unprotected left main or complex coronary artery disease, and should include a cardiac surgeon, an interventional cardiologist, and the patient.

9. Coronary artery bypass grafting or percutaneous coronary intervention is indicated to improve survival in survivors of sudden cardiac death with presumed ischemia-mediated ventricular tachycardia caused by significant (≥70% diameter) stenosis in a major coronary artery.

10. Patients with stable IHD should receive periodic follow-up at least annually, which includes all of the following: assessment of symptoms and clinical function; surveillance for complications of stable IHD including heart failure and arrhythmias; monitoring of cardiac risk factors; and assessment of the adequacy of and adherence to recommended lifestyle changes and medical therapy.

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Nonstatins, Novel Agents, Statins, Acute Heart Failure, Interventions and ACS, Interventions and Coronary Artery Disease, Hypertension

Keywords: Myocardial Ischemia, Acute Coronary Syndrome, Myocardial Infarction, Coronary Artery Disease, Platelet Aggregation Inhibitors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Percutaneous Coronary Intervention, Heart Failure, Hypertension, Diabetes Mellitus


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