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Revised Chronic Heart Disease Guidelines: GDMT, Imaging, Revascularization

Numerous recommendations align with previous guidance, but there is fresh advice for physicians treating chronic coronary disease. The new American guidelines for chronic coronary disease (CCD) modify management considerations for a diverse group that includes individuals with or without angina, a history of coronary revascularization, and previous acute coronary syndrome. Revised Chronic Heart Disease Guidelines: GDMT, Imaging, Revascularization.

Dr. Salim Virani, chairperson of the expert panel that rewrote the guidelines, stated that it is an entirely new guideline where all the necessary evaluations of evidence were conducted, and all the recommendations were rephrased. The chronic coronary disease guidelines, published in the AHA journal Circulation by the American Heart Association and American College of Cardiology, represent a significant update. Revised Chronic Heart Disease Guidelines: GDMT, Imaging, Revascularization.

Updated Recommendations for Chronic Heart Disease: GDMT, Imaging, and Revascularization Roles

According to the updated guidelines, outpatients with CCD should no longer initiate beta-blockers. Recent observational studies have led to a class III statement of non-recommendation for long-term beta-blocker therapy unless there has been a myocardial infarction (MI) within the past year, a left ventricular ejection fraction (LVEF) ≤50%, or another primary indication for beta-blocker therapy.

Revised Chronic Heart Disease Guidelines: GDMT, Imaging, Revascularization

The comprehensive guidelines also include updated recommendations for the use of beta-blockers, sodium-glucose cotransporter-2 (SGLT2) inhibitors, and glucagon-like peptide-1 (GLP1) receptor agonists in select patients. For patients with CCD who are already on beta-blockers due to a previous MI without a history of or current LVEF ≤50%, angina, arrhythmias, or uncontrolled hypertension, the guideline authors suggest reassessing the indication for long-term beta-blocker therapy to reduce major adverse cardiovascular events, classified as a class IIb recommendation. The guidelines cover a wide range of topics, from exercise and cholesterol management to bypass surgery.

Fresh Guidelines on Chronic Heart Disease: GDMT, Imaging, and Revascularization Revisions

Dr. Kristin Newby, the vice chairperson of the writing panel, described the guidelines as a one-stop shop for providers who care for patients with chronic coronary disease. Chronic coronary disease encompasses various conditions related to the buildup of plaque in artery walls, leading to restricted blood flow to the heart, such as coronary artery disease, angina, heart attack, and post-procedure care for blocked heart arteries.

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