New guidelines from AHA/ACC on managing patients with chronic CAD

6 Sept 2023 • The new guideline from the American Heart Association and the American College of Cardiology recommends against the long-term use of beta-blocker therapy in every patient with chronic CAD.

In patients with chronic coronary disease in the absence of myocardial infarction (MI) in the past year, left ventricular ejection fraction (LVEF) < 50%, or another primary indication for beta- blocker therapy, long-term use of beta-blocker therapy is no longer recommended.

The guidelines also suggested calcium channel blockers or beta-blockers as first-line antianginal therapy. Another key recommendation suggests using SGLT2 inhibitors and GLP1 receptor agonists for selected patients with chronic coronary disease, including groups without diabetes.

The revised guidelines also advised that dual anti-platelet therapy (DAPT) for shorter periods of time is generally safe and effective, especially when the risk of ischemic events is low to moderate and the risk of bleeding is high.

The 2023 guideline also recommended non-pharmacological interventions for all patients with chronic coronary disease, including healthy dietary habits and exercise. Cardiac rehabilitation was noted to have significant cardiovascular benefits in eligible patients, including decreased morbidity and mortality outcomes.

It has also been stated that routine periodic anatomic or ischemic testing without a change in clinical or functional status is not recommended for risk stratification or therapeutic decision-making in patients with chronic coronary disease.

The updated guidelines focus on the value of team-based, patient-centered care taking into account social determinants of health and related costs and incorporates shared decision-making in risk assessment, testing, and treatment.

Source: AHA | Read full story

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