AATS/ACC/AHA/SCAI/STS Diagnosis and Management of Patients With Stable Ischemic Heart Disease Guideline Summary

Diagnosis

Clinical Evaluation in the Initial Diagnosis of SIHD in Patients With Chest Pain

Patients with chest pain should receive a thorough history and physical examination to assess the probability of IHD before additional testing. (C, I)

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Patients who present with acute angina should be categorized as stable or unstable. Patients with unstable angina (UA) should be further categorized as being at high, moderate, or low risk ( C , I )

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A resting electrocardiogram (ECG) is recommended in patients without an obvious, noncardiac cause of chest pain. ( B , I )

701

Treatment

Patient Education

Patients with SIHD should have an individualized education plan to optimize care and promote wellness, including:

Education on the importance of medication adherence for managing symptoms and retarding disease progression ( C , I )

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An explanation of medication management and cardiovascular risk reduction strategies in a manner that respects the patient’s level of understanding, reading comprehension, and ethnicity ( B , I )

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A comprehensive review of all therapeutic options ( B , I )

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A description of appropriate levels of exercise, with encouragement to maintain recommended levels of daily physical activity. ( C , I )

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Introduction to self-monitoring skills ( C , I )

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Information on how to recognize worsening cardiovascular symptoms and take appropriate action. ( C , I )

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Patients with SIHD should be educated about the following lifestyle elements that could influence prognosis:

Weight control – maintenance of a body mass index (BMI²) of 18.5-24.9 kg/mand maintenance of a waist circumference <102 cm (40 inches) in men and <88 cm (35 inches) in women (less for certain racial groups)

Lipid management
Blood pressure (BP) control
Smoking cessation and avoidance of exposure to secondhand smoke
Individualized medical, nutrition, and lifestyle changes for patients with diabetes mellitus to supplement diabetes treatment goals and education.

( C , I )

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It is reasonable to educate patients with SIHD about:

Adherence to a diet that is low in saturated fat, cholesterol, and trans fat; high in fresh fruits, whole grains, and vegetables; and reduced in sodium intake, with cultural and ethnic preferences incorporated ( B , IIa )

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Common symptoms of stress and depression to minimize stress-related angina symptoms ( C , IIa )

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Comprehensive behavioral approaches for the management of stress and depression ( C , IIa )

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Evaluation and treatment of major depressive disorder when indicated. ( B , IIa )

Diagnosis and Management of Patients With Stable Ischemic Heart Disease