This post was authored by Morton J. Kern, MD, FACC, professor of medicine and associate chief of cardiology at the University California Irvine.

In the current digital age, groups of interested individuals are now able to communicate in unique ways that weren’t previously available except at large in-person meetings.  Recently a listserv comprised of cardiac cath lab experts generated several interesting conversations regarding simple questions which evolved into complex, controversial and highly informative exchanges of opinion, facts, conventional and unconventional wisdom.  We have published several of these “Conversations in Cardiology” in Cath Lab Digest, Catheterization and Cardiovascular Interventions, and now on CardioSource.org.

Recently, Peter Block, MD, FACC, associate editor of Science and Quality Video News on CardioSource.org, asked, “What are the antianginals that a PCI operator can list to support moving ahead after ‘maximal medical therapy’?”  While working on a quality review he noticed the appropriate use criteria (AUC) for PCI state that patients need to be on “two classes of antianginal medications” before intervention. The AUC criteria carefully define “two classes of antianginals.” Does this mean that one always needs two of the four true antianginal meds – calcium channel blockers, beta blockers, nitrates, or ranolazine – to be in compliance with the AUC?  If a cardiologist reports his patient received statins, ACEIs and ARBs as well, does this constitute maximal medical therapy?  While there is evidence that statins and ACEs may decrease angina, is this approach in keeping with the spirit of the AUC?

This simple question blossomed into a large and wide ranging discussion among the distinguished contributors that questioned whether any medication that improved the patient’s ischemic symptoms should be considered ‘anti-ischemic’ medication, as well as the following:  What was the basis for or studies used by the writing committee to form their particular recommendations? Are the AUC recommendations in keeping with common sense and daily accepted practice?  Several of the contributors, including members of the writing groups, chimed in and pointedly enlightened us on their deliberations of these issues.  It was a truly enlightening discussion.

At the end of the day, the ultimate value of exchanging these views among ourselves and now to the greater cardiology community is the understanding of the utility and limitations of rules, recommendations, guidelines, and how they contribute to the better care of our patients.

I hope you find the “Conversations in Cardiology: How do the AUC Define Antianginal Medications?” as interesting as my colleagues and I did.

Also, read more about a recent AUC usability survey that identified benefits and opportunities for improvement in the spring issue of Cardiology magazine.

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