Scope and Target Population:Adults aged 18 and over who meet the stated guideline criteria as identified in Annotation #1, "Patient with Stable Coronary Artery Disease."
Clinical Highlights and Recommendations:- 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, stress, 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 EKG 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.
Priority Aims- Improve selection and education of patients with stable CAD on the use of aspirin and antianginal drugs.
- Improve patient understanding of management of stable CAD.
- Increase the percentage of patients with stable CAD who receive an intervention for modifiable risk factors.
- Improve assessment of patient's anginal symptoms.
- Increase the use of ACE inhibitors in all patients with CAD who also have diabetes and/or LVSD, or other cardiovascular diseases.
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