Management of Stable Ischemic Heart Disease: Recommendations From the American College of Physicians, American College of Cardiology Foundation, American Heart Association, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, and Society of Thoracic Surgeons FREE

Members of the American College of Physicians (ACP) are internists—specialists in the care of adults. The ACP developed the recommendations with the American College of Cardiology Foundation, American Heart Association, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, and Society of Thoracic Surgeons.

In ischemic heart disease, blockages in blood vessels lead to low blood flow to the heart, which can cause chest pain (angina) or other symptoms, such as shortness of breath. If low blood flow is severe and lasts long enough, a section of heart muscle dies, a condition called myocardial infarction or “heart attack.”

Ischemic heart disease can be “unstable” or “stable.” People with unstable ischemic heart disease have symptoms that are rapidly worsening and occur at lower levels of exertion or at rest. Patients with stable ischemic heart disease (SIHD) have chest pain or other symptoms that occur at predictable levels of exertion and can be controlled with rest. The goals of SIHD treatment are to keep disease from becoming unstable; control symptoms to maintain quality of life; and avoid heart attack, other complications, and early death.

The ACP and the other associations reviewed studies published through November 2011 on the benefits and harms of treatments of SIHD and then used standard methods to rate the quality of information and make recommendations about managing patients with SIHD.

The initial approach for patients with SIHD should focus on eliminating unhealthy behaviors and treating high blood pressure, diabetes, and cholesterol problems. Certain drugs and procedures are effective at reducing symptoms, and others can help improve survival. It is important to keep these 2 separate outcomes in mind when developing a treatment plan.

The ACP concludes that there is no single best way to manage SIHD. Doctors and patients should consider patient preferences and personal situation when deciding on treatment for SIHD. The ACP offers 48 recommendations about when to consider specific treatments for patients with SIHD. The recommended treatment strategy starts with patient education about ways to reduce risk with healthy diet, exercise, avoidance of smoking, and weight control. In addition, medications should be used to control blood pressure, cholesterol levels, and diabetes. Influenza vaccination and drugs, such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers, can help to prevent heart attack or death. Other medications, such as nitroglycerin, can help to control symptoms. Certain patients may benefit from stenting or surgery to restore blood flow.

These recommendations are based on evidence published through November 2011 and might not reflect studies published since that time.