Primary Care Management of Chronic Stable Angina and Asymptomatic Suspected or Known Coronary Artery Disease: A Clinical Practice Guideline from the American College of Physicians

5 October 2004 | Volume 141 Issue 7 | Pages 562-567

In 1999, the American College of Physicians (ACP), then the American College of Physicians–American Society of Internal Medicine, and the American College of Cardiology/American Heart Association (ACC/AHA) developed joint guidelines on the management of patients with chronic stable angina. The ACC/AHA then published an updated guideline in 2002, which ACP recognized as a scientifically valid review of the evidence and background paper. This ACP guideline summarizes the recommendations of the 2002 ACC/AHA updated guideline and underscores the recommendations most likely to be important to physicians seeing patients in the primary care setting. This guideline is the second of 2 that provide guidance on the management of patients with chronic stable angina. This document covers treatment and follow-up of symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months. Sections addressing asymptomatic patients are also included. Asymptomatic refers to patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests. A previous guideline covered diagnosis and risk stratification for symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months and asymptomatic patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests.

*This paper, written by Vincenza Snow, MD; Patricia Barry, MD, MPH; Stephan D. Fihn, MD, MPH; Raymond J. Gibbons, MD; Douglas K. Owens, MD; Sankey V. Williams, MD; Christel Mottur-Pilson, PhD; and Kevin B. Weiss, MD, MPH, for the American College of Physicians/American College of Cardiology Chronic Stable Angina Panel, was developed for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians (ACP): Kevin B. Weiss, MD, MPH (Chair); Mark Aronson, MD; Patricia Barry, MD, MPH; Donald E. Casey Jr., MD, MPH, MBA; Thomas Cross Jr., MD, MPH; Nick Fitterman, MD; E. Rodney Hornbake, MD; Douglas K. Owens, MD; and Katherine D. Sherif, MD. Approved by the ACP Board of Regents in April 2004.

Author and Article Information

From the American College of Physicians and University of Pennsylvania, Philadelphia, Pennsylvania; Merck Institute of Aging and Health, Washington, DC; Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Mayo Clinic, Rochester, Minnesota; Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and Hines Veterans Administration Hospital and Northwestern University, Chicago, Illinois.

Annals of Internal Medicine encourages readers to copy and distribute this paper, providing such distribution is not for profit. Commercial distribution is not permitted without the express permission of the publisher.

Note: Clinical practice guidelines are "guides" only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP clinical practice guidelines are considered automatically withdrawn, or invalid, 5 years after publication or once an update has been issued.

Grant Support: Financial support for ACP guideline development comes exclusively from the ACP operating budget.

Potential Financial Conflicts of Interest:Employment: P. Barry (Merck Institute of Aging and Health); Consultancies: R.J. Gibbons (CV Therapeutics, DOV Pharmaceuticals, King Pharm, Medicure, Boehringer Ingelheim, Hawaii Biotech, GlaxoSmithKline, TargeGen); Stock ownership or options (other than mutual funds): P. Barry (Merck & Co., Inc.); Grants received: P. Barry (Merck Company Foundation), R.J. Gibbons (Medtronic, King Pharm, Wyeth-Ayerst, Radiant Medical, Alsius Corp., TherOx, Innercool Therapies, Boston Scientific), S.V. Williams; Grants pending: R.J. Gibbons (Boehringer Ingelheim).

Requests for Single Reprints: Vincenza Snow, MD, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, vincenza{at}mail.acponline.org.

Current Author Addresses: Drs. Snow and Mottur-Pilson: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

Dr. Barry: Merck Institute of Aging and Health, 1100 New York Avenue NW, Washington, DC 20005.

Dr. Fihn: Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, MS152, Seattle, WA 98108.

Dr. Gibbons: Mayo Clinic, 200 First Street SW, Rochester, MN 55906.

Dr. Owens: Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304.

Dr. Williams: University of Pennsylvania, 1220 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.

Dr. Weiss: Hines Veterans Administration Hospital (151H), PO Box 5000, Hines, IL 60141.

Read all Rapid Responses

Use of cardiac testing during followup P 565

john m hedley

Annals Online, 6 Oct 2004 [Full text]