This guideline is an evidence-based, patient-centered approach.
The 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guidelines for the Management of Patients with Chronic Coronary Heart Disease updates and combines new data from the 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guidelines for the Diagnosis and Management of Patients with Stable Coronary Heart Disease and the corresponding Guidelines for the Diagnosis and Management of Patients with Stable Coronary Heart Disease.
A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other human data have been identified and published in English in MEDLINE (via PubMed), EMBASE, the Cochrane Library, the Agency for Research and Quality in Health Care, and other selected databases relevant to this guideline.
This guideline presents an evidence-based and patient-centered approach to the management of patients with chronic coronary disease, taking into account the social determinants of health and incorporating the principles of collaborative decision-making and collective care. Relevant topics include general treatment approaches, management, and therapy as recommended to reduce symptoms and future CV events, decision making related to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas requiring future research.
Where appropriate, and based on the availability of cost-effectiveness data, cost recommendations for clinicians are also provided. Many previously published recommendations have been supplemented by new evidence and new recommendations based on published data.
Clinical practice guidelines provide recommendations applicable to patients with or at risk of cardiovascular disease (CVD). The focus is on medical practice in the United States, but these guidelines apply to patients worldwide. While the guidelines may be used to inform payers or regulators, their purpose is to improve the quality of care and align it with the best interests of patients. The guidelines are intended to identify methods that meet the needs of patients in most but not all circumstances and should not replace clinical judgment.
Clinical Implementation Management
According to the guidelines, it is effective only when followed by both physicians and patients. Adherence can be improved through collaborative decision making between physicians and patients, with patient participation in the choice of interventions based on individual values, preferences, and associated conditions and comorbidities.
10 Key Leadership Messages
1. The emphasis is on patient-centered, participatory care that addresses the social determinants of health along with associated costs, and includes shared decision-making in risk assessment, testing and treatment.
2. All patients with chronic coronary disease (CHD) are recommended non-pharmacological treatments, including a healthy diet and exercise.
3. Patients with chronic coronary disease (CHD) who do not have contraindications are recommended to participate in physical activity routine, including activities to reduce sitting time and increase aerobic and strength training. Cardiac rehabilitation for eligible patients, it provides significant cardiovascular benefits, including reduced rates of morbidity and mortality.
4. The use of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists is recommended for certain groups of patients with chronic coronary disease (CHD), including groups without diabetes mellitus.
5. New recommendations for the use of beta-blockers in patients with chronic coronary disease (CHD):
a) Long-term therapy with beta blockers to improve outcomes in patients with chronic coronary disease (CHD) in the absence of myocardial infarction within the past year, left ventricular ejection fraction ≤50%, or other primary indications for beta-blocker therapy.
b) recommended calcium channel blocker or beta blocker as first line antianginal therapy.
6. statins they remain the first line of lipid-lowering therapy in patients with chronic coronary heart disease (CHD). Some adjuvant therapies (eg, ezetimibe, PCSK9 inhibitors (proprotein convertase subtilisin/kexin type 9), inclisiran, bempedoic acid) may be used in selected populations, although clinical outcome data are not available for newer drugs such as inclisiran.
7. Shortest validity period dual antiplatelet therapy they are safe and effective in many settings, especially those with high risk of bleeding and low to moderate risk of ischemia.
8. The use of over-the-counter or dietary supplements, including fish oil and omega-3 fatty acids or vitamins, is not recommended in patients with chronic coronary disease (CHD) due to lack of benefit in reducing cardiovascular events.
9. not recommended periodic anatomical or ischemic tests routinely without changing clinical or functional status for risk stratification or for making therapeutic decisions in patients with chronic coronary disease (CHD).
10. Although e-Sigs they increase the likelihood of successful smoking cessation compared to nicotine replacement therapy, due to the lack of long-term safety data and the risks of long-term use, e-cigarettes are not recommended as first-line therapy for smoking cessation.
Comments and recommendations for patients
The new guidelines detailing how to care for people with heart disease include some easy-to-understand warnings for patients.
The American Heart Association/American College of Cardiology guidelines for chronic coronary disease, published in the journal AHA Circulation, are not incremental updates, said Dr. Salim Virani, chair of the panel that rewrote them.
“This is actually a new guideline that has revisited everything that needed to be assessed in terms of evidence and rewritten all the recommendations,” said Virani, Vice Provost for Research and Professor of Medicine at the Aga Khan University in Karachi, Pakistan.
Coronary artery disease includes several conditions that can be traced back to plaque buildup on the walls of the arteries, which restricts blood flow to the heart. This includes coronary heart disease, angina pectoris, heart attack, and care after surgery to open a blocked heart artery.