Vincenza Snow, MD; Patricia Barry, MD, MPH; Stephan D. Fihn, MD, MPH; Raymond J. Gibbons, MD; Douglas K. Owens, MD; Sankey V. Williams, MD; Kevin B. Weiss, MD, MPH; Christel Mottur-Pilson, PhD; the ACP/ACC Chronic Stable Angina Panel*
Snow V, Barry P, Fihn SD, Gibbons RJ, Owens DK, Williams SV, et al. Evaluation of Primary Care Patients with Chronic Stable Angina: Guidelines from the American College of Physicians. Ann Intern Med. 2004;141:57-64. doi: 10.7326/0003-4819-141-1-200407060-00015
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Published: Ann Intern Med. 2004;141(1):57-64.
In 1999, the American College of Physicians (ACP), then the American College of Physiciansâ€“American Society of Internal Medicine, and the American College of Cardiology/American Heart Association (ACC/AHA) developed joint guidelines on the management of patients with chronic stable angina. The ACC/AHA then published an updated guideline in 2002, which the ACP recognized as a scientifically valid review of the evidence and background paper. This ACP guideline summarizes the recommendations of the 2002 ACC/AHA updated guideline and underscores the recommendations most likely to be important to physicians seeing patients in the primary care setting. This guideline is the first of 2 that will provide guidance on the management of patients with chronic stable angina. This document will cover diagnosis and risk stratification for symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months. Sections addressing asymptomatic patients are also included. Asymptomatic refers to patients with known or suspected coronary disease based on history or on electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests. A future guideline will cover pharmacologic therapy and follow-up.
* This paper, written by Vincenza Snow, MD; Patricia Barry, MD, MPH; Stephan D. Fihn, MD, MPH; Raymond J. Gibbons, MD; Douglas K. Owens, MD; Sankey V. Williams, MD; Kevin B. Weiss, MD, MPH; and Christel Mottur-Pilson, PhD, was developed for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians (ACP): Kevin B. Weiss, MD (Chair); Mark Aronson, MD; Patricia Barry, MD; Thomas Cross Jr., MD, MPH; Nick Fitterman, MD; E. Rodney Hornbake, MD; Douglas K. Owens, MD; and Katherine D. Sherif, MD. Approved by the ACP Board of Regents in January 2004.
*In unusual circumstances (patients who are survivors of sudden cardiac death, have congestive heart failure, have special occupational requirements, or have stable but severe symptoms and cardiac risk factors), direct referral for cardiac angiography may be appropriate. ACC = American College of Cardiology; ECG = electrocardiogram; LV = left ventricular; MI = myocardial infarction; WPW = Wolff–Parkinson–White syndrome.
CAD = coronary artery disease; MI = myocardial infarction.
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