2012 Stable Ischemic Heart Disease Guidelines Update
The most recent focused update to the ACC/AHA Guidelines for the Management of Patients With Chronic Stable Angina was published in 2002.
These guidelines provided recommendations on diagnosis, risk stratification, treatment, and patient follow-up. Since 2002, results from a number of important
clinical trials have prompted an overall update to the guidelines. This activity will discuss the 2012 update of the ACC/AHA Guidelines for the Management of
Patients With Stable Ischemic Heart Disease. Discussion will focus on current recommendations for diagnosis, risk stratification, treatment, and patient follow-up
recommendations and review key data.
Content Developed by Julius Gardin, MD, MBA, FACC, FACP, FAHA, FASE
Clinical Perspectives in Stable Ischemic Heart Disease: A Case-Based Approach
Substantial progress has been made in screening, prevention, risk stratification, and treatment of stable ischemic heart disease. Despite the
availability of practice guidelines (ie, ACC/AHA for exercise testing, secondary prevention of CAD, appropriate use of stress echocardiography, and the Management
of Patients With Chronic Stable Angina, among others), many questions remain on risk-stratification testing strategies and subsequent treatment approaches. This
program will utilize a case-based approach to illustrate lessons learned from clinical practice on screening, risk stratification, and therapeutic challenges not
adequately addressed by controlled clinical trial data.
Content developed by David Morrow, MD
Diabetes and Stable Ischemic Heart Disease
This activity will discuss the epidemiologic
trends as well as the health and economic burden of diabetes and SIHD.
In addition, discussion will include important pathophysiologic factors in
diabetes and SIHD, risk stratification, and management approaches in
patients with diabetes with stable ischemic heart disease.
Content developed by Bernard Chaitman, MD.
Epidemiology, Pathophysiology, and Therapeutic Targets in Stable Ischemic Heart Disease
This activity will discuss the epidemiologic
trends as well as the health and economic burden of stable ischemic heart disease (SIHD),
focusing on chronic stable angina. In addition, discussion will include important pathophysiologic
factors in chronic angina and their implications with regard to traditional and new therapeutic targets.
Content updated by Peter Stone, MD
Left Ventricular Dysfunction and Stable Ischemic Heart Disease
Left ventricular dysfunction with chronic ischemia is present in a number of clinical syndromes
in which myocardial revascularization results in an improvement of left ventricular function, patients’ functional class,
and their survival. However, early diagnosis of and treatment of viability is essential for success.
A number of non-invasive testing modalities are useful in making a diagnosis. However, no single test has a perfect
sensitivity and specificity, and thus, a combination of tests are usually needed. Algorithms are developed to integrate
these tests in clinical decision making. This program will discuss the pathophysiology of chronic left ventricular dysfunction, assessment of fibrosis and/or myocardial viability, and medical and interventional approaches to management.
Content developed by James Fang, MD, FACC
Management Considerations for Patients with Stable Ischemic Heart Disease
This activity will address general goals of therapy in
patients with stable ischemic heart disease (SIHD), with a focus on
chronic stable angina and include discussion of major clinical trials
of anti-ischemic agents and vasculoprotective options and prognosis of
those on medical therapy. Further, the discussion will include a review
of optimal medical therapy and comparison of surgical and interventional
approaches to management.
Content Updated by William Boden, MD, FACC, FAHA
Stable Ischemic Heart Disease: General Medicine Practices for Healthcare Providers
This activity will discuss current recommendations in the context of the
education needs of primary care and allied health care providers (eg, physicians, physician assistants, and nurse practitioners).
Discussion will focus on current recommendations for diagnosis, risk stratification, treatment, when to refer to a specialist,
and patient follow-up recommendations provided by the ACC and AHA for patients with stable ischemic heart disease.
Content developed by Kathy Berra, NP
Stable Ischemic Heart Disease: Risk Stratification
The natural history of coronary artery disease spans many decades and includes cyclic phases of
clinically predefined phases (ie, asymptomatic, stable angina, progressive angina, and unstable angina or
myocardial infarction). There are different approaches to risk stratification of coronary disease depending
on the phase of an individual’s disease. In general, the patient’s risk for death or nonfatal MI is usually a
function of left ventricular function, anatomic extent and severity of atherosclerotic involvement, evidence of
recent coronary plaque rupture, and general health and noncoronary comorbidity. Developing a level of risk
for a particular patient helps to communicate overall prognosis to the patient, as well as assist in
determining appropriate treatment. This program will discuss approaches to risk stratification for
patients with SIHD, the probability of developing coronary heart disease, and how to determine the
appropriate treatment pathway for a given patient type.
Content developed by Bernard Chaitman, MD
Stable Ischemic Heart Disease: Screening and Diagnostic Modalities
The prognosis of patients with stable ischemic heart disease (SIHD)
is variable and dependent on the presence of other factors and comorbidities. Clinical evaluation,
laboratory testing, and specific cardiac testing procedures are integral tools in patient screening
and formulating a diagnosis. Non-invasive and invasive cardiac tests are used to confirm the presence
of myocardial ischemia, identify the location and extent of coronary atherosclerosis, identify potential
precipitating factors, assess long-term prognosis, and in some settings, evaluate efficacy of treatment.
This program will discuss screening and diagnostic modalities for SIHD, clinical classification
of chest pain, probability estimates for developing coronary artery disease and gender considerations
in the evaluation and diagnosis of SIHD.
Content developed by Christopher Cannon, MD
Women and Stable Ischemic Heart Disease
This activity will discuss the epidemiologic
trends as well as the health and economic burden of SIHD in women.
In addition, discussion will include important pathophysiologic factors in
SIHD, diagnostic approaches, risk stratification, and management approaches in
women with stable ischemic heart disease.
Content developed by Nanette Wenger, MD, MACC, MACP, FAHA
Educational topics/slide presentations are determined by
needs assessments, educator recommendations and regional CME/CE program attendee
evaluations.
Content is produced by Expert Exchange faculty and evaluated by an independent
reviewer in accordance with ACCME Guidelines.