ACP, other orgs promote updated guidelines for treating ischemic heart disease


Six physician-friendly organizations have come together to produce and endorse two new sets of clinical guidelines for treating stable ischemic heart disease (IHD) — a condition known to affect one out of every three adults in the country.

“Stable ischemic heart disease is a major public health issue,” said David L. Bronson, MD, FACP, president of the American College of Physicians (ACP) —one such promoter and publisher of the guidelines — in a news release. “Although survival of patients with the disease has been steadily improving, it was still responsible for nearly 380,000 deaths in the United States in 2010.”

Recommendations in the first issued report, titled “Evaluation of Patients with Stable Ischemic Heart Disease,” advise on how physicians should address the following:

  • Initial cardiac testing to diagnose stable IHD
  • Cardiac stress testing to assess risk in patients with known stable IHD who are able to exercise, who are unable to exercise, and regardless of ability to exercise
  • Coronary angiography as an initial testing strategy to assess risk in patients with stable IHD
  • Coronary angiography to assess risk after initial workup with noninvasive testing

Additionally, on the grounds of chest pain or angina, the organizations adamantly suggested that patients with such discomfort should receive a thorough history and physical examination to assess the probability of stable IHD prior to continued testing. Furthermore, diagnostic and therapeutic decrees should be made via shared decision-making process, where the physician and the patient converse over aspects of the procedure including benefits, harms and possible costs to the patient.

The second issued report, “Management of Patients with Stable Ischemic Heart Disease,” imparts suggestions regarding 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.

“Educating patients with stable IHD in the areas of weight control, proper nutrition, lipid management, blood pressure control and smoking cessation may influence prognosis,” Bronson remarked.

The organizations encouraged physicians to do the following in regard to risk reduction for patients with stable IHD because of their unproven benefit:

  • Estrogen therapy should not be initiated in postmenopausal women.
  • Vitamin C, vitamin E and beta-carotene supplementation should not be used.
  • Treatment of elevated homocysteine with folate and/or vitamins B6 and B12 should not be used.

Aspirin should be relegated to 75-162 daily mg indefinitely if contraindications in patients with stable IHD are absent, the guidelines indicate.

Another recommendations for patients with stable IHD included a periodic follow-up involving an assessment of symptoms and clinical function, surveillance for complications of stable IHD including heart failure and arrhythmias, monitoring of cardiac risk factors and an assessment of the adequacy of and adherence to recommended lifestyle changes and medical therapy.

Alongside the ACP, other organizational guideline collaborators include: 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.

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