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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

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The full report is titled “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.” It is in the 20 November 2012 issue of Annals of Internal Medicine (volume 157, pages 735-743). The authors are A. Qaseem, S.D. Fihn, P. Dallas, S. Williams, D.K. Owens, and P. Shekelle, for the Clinical Guidelines Committee of the American College of Physicians.

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Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

Ann Intern Med. 2012;157(10):I-48. doi:10.7326/0003-4819-157-10-201211200-00003
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Who developed these guidelines?

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.

What is the problem and what is known about it so far?

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.

How did the ACP develop these recommendations?

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.

What did the authors find?

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.

What does the ACP recommend that patients and doctors do?

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.

What are the cautions related to these recommendations?

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





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