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Guidelines for Chronic Coronary Disease

On Friday, July 21, 2023, the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines published a report in Circulation and the Journal of the American College of Cardiology, presenting recommendations for the diagnosis and management of chronic coronary disease (CCD). Guidelines for Chronic Coronary Disease.

One noteworthy recommendation from the American Heart Association (AHA) and American College of Cardiology (ACC) states that outpatients with CCD should no longer begin beta-blockers. This recommendation is based on recent observational studies, which have led to a class III statement of non-recommendation for long-term beta-blocker therapy in cases where there has been no myocardial infarction (MI) in the past year, left ventricular ejection fraction is greater than 50%, or another primary indication for beta-blocker therapy is absent.

Comprehensive Recommendations Issued for Chronic Coronary Disease Management

The cornerstone of managing chronic coronary disease (CCD) for the more than 20 million people diagnosed in the U.S. remains a healthy lifestyle and dietary habits. This is highlighted in the first comprehensive guideline update on CCD in a decade from the American Heart Association and the American College of Cardiology.

Guidelines for Chronic Coronary Disease

To provide these guidelines, Salim S. Virani, M.D., Ph.D., and colleagues from the Baylor College of Medicine in Houston conducted a thorough literature review to update and consolidate the latest evidence concerning the diagnosis and management of patients with stable ischemic heart disease.

Latest Guidelines for Chronic Coronary Disease Diagnosis and Treatment

The guideline also emphasizes the importance of collaboration among primary care clinicians and various members of the cardiology team to treat CCD, as well as updates recommendations on follow-up screening, medications, and dietary supplements.

The writing committee, chaired by Salim Virani, MD, PhD, from the Aga Khan University in Karachi City, Pakistan, and Texas Heart Institute, Houston, emphasizes an evidence-based and patient-centered approach to managing patients with chronic coronary disease. They take into account social determinants of health and incorporate principles of shared decision-making and team-based care.

Evidence-Based Approaches for Addressing Chronic Coronary Disease

According to the authors, team-based, patient-centered care considers social determinants of health, associated costs, and incorporates shared decision-making in risk assessment, testing, and treatment. For the more than 20 million people in the U.S. with chronic coronary disease, adhering to a heart-healthy diet and lifestyle is crucial in preventing further health deterioration, as recommended by the latest joint guideline from the American Heart Association and the American College of Cardiology.

Virani and colleagues note that CCD encompasses conditions of obstructive and nonobstructive coronary artery disease (CAD) with or without previous MI or revascularization, ischemic heart disease diagnosed only by noninvasive testing, and chronic angina syndromes with varying underlying causes. They estimate that approximately 20.1 million people live with CCD in the U.S.

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