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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."Adults 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 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.

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 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.
Priority Aims

1. Increase the percentage of appropriate patients with an appropriate diagnosis of stable coronary artery disease (SCAD), who are prescribed aspirin and antianginal medications.
   
2. Improve education/understanding around the management of stable coronary artery disease.
   
3. Increase the percentage of patients with stable coronary artery disease who receive an intervention for modifiable risk factors.
   
4. Improve the assessment of patients with a diagnosis of stable coronary artery disease who present with angina symptoms.
   
5. Increase the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBS) in patients with coronary artery disease, including those patients with a diagnosis of diabetes, chronic kidney disease, and hypertension.
   
6. Increase the percentage of patients with a diagnosis of stable coronary artery disease who receive education around nutritional supplement therapy.
   
7. Increase prognostic testing for patients whose risk determination remains unclear.