Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms: Difference between revisions
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'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[John Fani Srour, M.D.]]; Jinhui Wu, MD | '''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[John Fani Srour, M.D.]]; Jinhui Wu, MD | ||
==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id= | ==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref><ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>== | ||
{{cquote| | {{cquote| | ||
===Class I=== | ===Class I=== | ||
'''1.''' [[Aspirin]] should be started at 75 to 162 mg per day and continued indefinitely in all patients unless contraindicated.''(Level of Evidence: A)'' | '''1.''' [[Aspirin]] should be started at 75 to 162 mg per day and continued indefinitely in all patients unless contraindicated. ''(Level of Evidence: A)'' | ||
'''2.''' [[ | '''2.''' Use of [[warfarin]] in conjunction with [[aspirin]] and/or [[clopidogrel]] is associated with an increased risk of bleeding and should be monitored closely. ''(Level of Evidence: B)'' | ||
'''3.''' [[ | '''3.''' It is beneficial to start and continue [[beta-blocker]] therapy indefinitely in all patients who have had [[MI]], [[acute coronary syndrome]], or [[left ventricular dysfunction]] with or without [[heart failure]] symptoms, unless contraindicated. ''(Level of Evidence: A)'' | ||
'''4.''' [[ | '''4.''' [[Calcium antagonists]] (short-acting [[dihydropyridine calcium antagonist]]s should be avoided) and/or long-acting [[nitrates]] as initial therapy for reduction of symptoms when beta-blockers are contraindicated. ''(Level of Evidence: B)'' | ||
'''5.''' [[ | '''5.''' [[Calcium antagonists]] (short-acting [[dihydropyridine calcium antagonist]]s should be avoided) and/or long-acting [[nitrate]]s in combination with [[beta-blockers]] when initial treatment with [[beta-blockers]] is not successful. ''(Level of Evidence: B)'' | ||
'''6.''' [[ | '''6.''' [[Calcium antagonists]] (short-acting [[dihydropyridine calcium antagonist]]s should be avoided) and/or long-acting [[nitrate]]s as a substitute for [[beta-blockers]] if initial treatment with [[beta-blockers]] leads to unacceptable side effects. ''(Level of Evidence: C)'' | ||
'''7.''' [[ | '''7.''' Sublingual [[nitroglycerin]] or nitroglycerin spray for the immediate relief of [[angina]]. ''(Level of Evidence: C)'' | ||
'''8.''' [[ | '''8.''' Lipid-lowering therapy in patients with documented or suspected [[CAD]] and [[LDL]] cholesterol more than 130 mg/dL with a target [[LDL]] of less than 100 mg/dL. ''(Level of Evidence: A)'' | ||
'''9.''' | '''9.''' [[ACE inhibitors]] should be started and continued indefinitely in all patients with [[left ventricular ejection fraction]] less than or equal to 40% and in those with [[hypertension]], [[diabetes]], or [[chronic kidney disease]] unless contraindicated. ''(Level of Evidence: A)'' | ||
'''10.''' [[ | '''10.''' [[ACE inhibitors]] should be started and continued indefinitely in patients who are not lower risk (lower risk defined as | ||
those with normal [[left ventricular ejection fraction]] in whom cardiovascular risk factors are well controlled and [[revascularization]] has been performed), unless contraindicated. ''(Level of Evidence: B)'' | |||
'''11.''' [[ | '''11.''' [[Angiotensin receptor blockers]] are recommended for patients who have [[hypertension]], have indications for but are | ||
intolerant of ACE inhibitors, have [[heart failure]], or have had a [[myocardial infarction]] with left ventricular ejection | |||
fraction less than or equal to 40%. ''(Level of Evidence: A)'' | |||
'''12.''' [[ | '''12.''' [[Aldosterone antagonists]] is recommended for use in post-[[MI]] patients without significant renal dysfunction or | ||
[[hyperkalemia]] who are already receiving therapeutic doses of an [[ACE inhibitor]] and a [[beta blocker]], have a [[left | |||
ventricular ejection fraction]] less than or equal to 40%, and have either [[diabetes]] or [[heart failure]]. ''(Level of Evidence: A)'' | |||
===Class IIa=== | ===Class IIa=== | ||
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'''2.''' Long-acting nondihydropyridine [[calcium antagonists]] (short-acting [[dihydropyridine calcium antagonist]]s should be avoided) instead of [[beta-blockers]] as initial therapy. ''(Level of Evidence: B)'' | '''2.''' Long-acting nondihydropyridine [[calcium antagonists]] (short-acting [[dihydropyridine calcium antagonist]]s should be avoided) instead of [[beta-blockers]] as initial therapy. ''(Level of Evidence: B)'' | ||
'''3.''' | '''3.''' Lipid-lowering therapy in patients with documented or suspected [[CAD]] and [[LDL]] cholesterol 100 to 129 mg/dL, with a target [[LDL]] of 100 mg/dL. ''(Level of Evidence: B)'' | ||
'''4 | '''4.''' It is reasonable to use [[ACE inhibitors]] among lower-risk patients with mildly reduced or normal [[left ventricular | ||
ejection fraction]] in whom cardiovascular risk factors are well controlled and [[revascularization]] has been performed. ''(Level of Evidence: B)'' | |||
===Class IIb=== | ===Class IIb=== | ||
'''1.''' [[Angiotensin receptor blockers]] may be considered in combination with ACE inhibitors for heart failure due to left ventricular systolic dysfunction | '''1.''' [[Angiotensin receptor blockers]] may be considered in combination with [[ACE inhibitors]] for [[heart failure]] due to | ||
[[left ventricular systolic dysfunction]]. ''(Level of Evidence: B)'' | |||
===Class III=== | ===Class III=== | ||
'''1.''' [[Dipyridamole]]. ''(Level of Evidence: B)'' | '''1.''' [[Dipyridamole]]. ''(Level of Evidence: B)'' | ||
'''2.''' [[Chelation therapy]]. ''(Level of Evidence: C)''}} | '''2.''' [[Chelation therapy]] (intravenous infusions of ethylenediamine tetraacetic acid or [[EDTA]]) is not recommended for the | ||
treatment of chronic [[angina]] or [[arteriosclerotic]] cardiovascular disease and may be harmful because of its potential to cause [[hypocalcemia]]. ''(Level of Evidence: C)''}} | |||
== | ==Vote on and Suggest Revisions to the Current Guidelines== | ||
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]] | *[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]] | ||
==Sources== | ==Sources== | ||
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref> | *Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref> | ||
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref> | |||
*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref> | *TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref> | ||
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72. [http:// | *The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref> | ||
==References== | ==References== |
Revision as of 18:06, 21 July 2011
Chronic stable angina Microchapters | ||
Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
Diagnosis | ||
Alternative Therapies for Refractory Angina | ||
Discharge Care | ||
Guidelines for Asymptomatic Patients | ||
Case Studies | ||
Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms On the Web | ||
FDA on Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms | ||
CDC onChronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms | ||
Editors-In-Chief: C. Michael Gibson, M.S., M.D. [4] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [5]; Associate Editors-In-Chief: John Fani Srour, M.D.; Jinhui Wu, MD
ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)[1][2][3]
“ |
Class I1. Aspirin should be started at 75 to 162 mg per day and continued indefinitely in all patients unless contraindicated. (Level of Evidence: A) 2. Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with an increased risk of bleeding and should be monitored closely. (Level of Evidence: B) 3. It is beneficial to start and continue beta-blocker therapy indefinitely in all patients who have had MI, acute coronary syndrome, or left ventricular dysfunction with or without heart failure symptoms, unless contraindicated. (Level of Evidence: A) 4. Calcium antagonists (short-acting dihydropyridine calcium antagonists should be avoided) and/or long-acting nitrates as initial therapy for reduction of symptoms when beta-blockers are contraindicated. (Level of Evidence: B) 5. Calcium antagonists (short-acting dihydropyridine calcium antagonists should be avoided) and/or long-acting nitrates in combination with beta-blockers when initial treatment with beta-blockers is not successful. (Level of Evidence: B) 6. Calcium antagonists (short-acting dihydropyridine calcium antagonists should be avoided) and/or long-acting nitrates as a substitute for beta-blockers if initial treatment with beta-blockers leads to unacceptable side effects. (Level of Evidence: C) 7. Sublingual nitroglycerin or nitroglycerin spray for the immediate relief of angina. (Level of Evidence: C) 8. Lipid-lowering therapy in patients with documented or suspected CAD and LDL cholesterol more than 130 mg/dL with a target LDL of less than 100 mg/dL. (Level of Evidence: A) 9. ACE inhibitors should be started and continued indefinitely in all patients with left ventricular ejection fraction less than or equal to 40% and in those with hypertension, diabetes, or chronic kidney disease unless contraindicated. (Level of Evidence: A) 10. ACE inhibitors should be started and continued indefinitely in patients who are not lower risk (lower risk defined as those with normal left ventricular ejection fraction in whom cardiovascular risk factors are well controlled and revascularization has been performed), unless contraindicated. (Level of Evidence: B) 11. Angiotensin receptor blockers are recommended for patients who have hypertension, have indications for but are intolerant of ACE inhibitors, have heart failure, or have had a myocardial infarction with left ventricular ejection fraction less than or equal to 40%. (Level of Evidence: A) 12. Aldosterone antagonists is recommended for use in post-MI patients without significant renal dysfunction or hyperkalemia who are already receiving therapeutic doses of an ACE inhibitor and a beta blocker, have a [[left ventricular ejection fraction]] less than or equal to 40%, and have either diabetes or heart failure. (Level of Evidence: A) Class IIa1. Clopidogrel when aspirin is absolutely contraindicated. (Level of Evidence: B) 2. Long-acting nondihydropyridine calcium antagonists (short-acting dihydropyridine calcium antagonists should be avoided) instead of beta-blockers as initial therapy. (Level of Evidence: B) 3. Lipid-lowering therapy in patients with documented or suspected CAD and LDL cholesterol 100 to 129 mg/dL, with a target LDL of 100 mg/dL. (Level of Evidence: B) 4. It is reasonable to use ACE inhibitors among lower-risk patients with mildly reduced or normal [[left ventricular ejection fraction]] in whom cardiovascular risk factors are well controlled and revascularization has been performed. (Level of Evidence: B) Class IIb1. Angiotensin receptor blockers may be considered in combination with ACE inhibitors for heart failure due to left ventricular systolic dysfunction. (Level of Evidence: B) Class III1. Dipyridamole. (Level of Evidence: B) 2. Chelation therapy (intravenous infusions of ethylenediamine tetraacetic acid or EDTA) is not recommended for the treatment of chronic angina or arteriosclerotic cardiovascular disease and may be harmful because of its potential to cause hypocalcemia. (Level of Evidence: C) |
” |
Vote on and Suggest Revisions to the Current Guidelines
Sources
- Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [4]
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [1]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [2]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [3]
References
- ↑ 1.0 1.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [1] PMID: 10351980
- ↑ 2.0 2.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[2] PMID: 12515758
- ↑ 3.0 3.1 Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[3] PMID: 17998462
- ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). %5bhttp://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf%5d "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology" Check
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value (help). Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.