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Coronary Artery Disease, Stable

Guideline Summary

Revision Date: May 2013
Fifteenth Edition

Scope and Target Population

Adults age 18 years or older who have a diagnosis of stable coronary artery disease. The criteria, as noted on the Main algorithm, includes patient presenting with:

  • previously diagnosed coronary artery disease (CAD) without angina, or symptom complex that has remained stable for at least 60 days;
  • no change in frequency, duration, precipitating causes or ease of relief of angina for at least 60 days; and
  • no evidence of recent myocardial damage.

Aims

  1. Increase the percentage of patients age 18 years and older with a diagnosis of stable coronary artery disease (SCAD) who are prescribed aspirin and antiatheroschlerotic medications.
  2. Increase the percentage of patients age 18 years and older with a diagnosis of stable coronary artery disease who understand the self-management of their condition.
  3. Increase the percentage of patients age 18 years and older with a diagnosis of stable coronary artery disease who receive education and an intervention for modifiable risk factors.
  4. Increase the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) in patients with stable coronary artery disease with systolic CHF (ejection fraction less than or equal to 40%), including those patients with a comorbidity diagnosis of chronic kidney disease and/or diabetes mellitus.
  5. Increase appropriate risk assessment and stress imaging for stable coronary artery disease patients to determine risk stratification prior to decisions on medical therapy and revascularization.

Clinical Highlights

  • Prescribe aspirin in patients with stable coronary artery disease if there are no medical contraindications.
  • Evaluate and treat the modifiable risk factors, which include smoking, sedentary activity level, depression, hyperlipidemia, obesity, hypertension and diabetes.
  • Patients with chronic stable coronary artery disease should be on statin therapy regardless of their lipid levels unless contraindicated.
  • Perform prognostic testing in patients whose risk determination remains unclear. This may precede or follow an initial course of pharmacologic therapy.
  • Refer the patient for cardiovascular consultation when clinical assessment indicates the patient is at high risk for adverse events, the non-invasive imaging study or electrocardiography indicates the patient is at high risk for an adverse event, or medical treatment is ineffective.
  • For relief of angina, prescribe beta-blockers as first-line medication. If beta-blockers are contraindicated, nitrates are the preferred alternative. Calcium channel blockers may be an alternative medication if the patient is unable to take beta-blockers or nitrates.