Six organizations representing physicians, other health care professionals, and patients issued two new clinical practice guidelines for diagnosing and treating stable ischemic heart disease (IHD), which affects an estimated one in three adults in the United States.
The American College of Physicians, the American Association for Thoracic Surgery, the American College of Cardiology Foundation, the American Heart Association, the Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons collaborated to create the guidelines.
Recommendations for evaluating patients with stable IHD address testing for patients who may or may not be able to exercise. Angina -- chest pain or discomfort occurring in an area of the heart that does not get enough blood -- is often a symptom of stable IHD. The organizations recommend that patients with chest pain should receive a thorough history and physical examination to assess the probability of stable IHD prior to additional testing.
Choices regarding diagnostic and therapeutic options should be made through a process of shared decision making between the patient and physician to discuss the risks, benefits, and costs to the patient. Recommendations for management of patients with stable IHD address patient education, risk factor modification, medical therapy to prevent myocardial infarction and death, medical therapy and alternative therapy for relief of symptoms, revascularization, and patient follow-up.
The guidelines are being published in Annals of Internal Medicine. The Journal of the American College of Cardiology is simultaneously publishing a longer version of the guidelines as one document.