The 2023 AHA/ACC Multisociety Guideline provides guidance for clinicians on managing patients with chronic coronary disease. This article will serve as a valuable resource for healthcare professionals seeking the latest recommendations in this field.

The recommendation notes the change from "stable ischaemic heart disease" to "chronic coronary disease." This modification replicates the most recent modification made by the European Society of Cardiology (ESC) and represents the continuum of treatment provided to patients with coronary artery disease from acute to chronic.

The suggestions are focused on managing chronic illnesses when the care team interacts with the patient often over an extended period of time. Because the length of treatment has changed for the management of chronic coronary disease, it is crucial for the care team to review drugs at each clinician-patient visit.

Practice-changing suggestions from the guideline are emphasised in this Guideline-at-a-Glance to speed its distribution.

Top ten key takeaways

Directly from the AHA/ACC Multisociety Chronic Coronary Disease Guideline, we've extracted the top ten takeaways.

1. Patient-centered care: The focus is on team-based, patient-centred care that incorporates shared decision-making in risk assessment, testing, and treatment while taking into account socioeconomic determinants of health and related costs.

2. Lifestyle interventions: Nonpharmacologic treatments, such as exercise and a balanced diet, are advised for all individuals with chronic coronary disease.

3. Physical activity: Patients with chronic coronary disease who do not have any contraindications are urged to engage in regular physical activity, including exercises that promote aerobic and resistance training and decrease sitting time. For suitable individuals, cardiac rehabilitation offers important cardiovascular advantages, such as lower rates of morbidity and death.

4. Medications for cardiovascular disease: Glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors are advised for certain individuals with chronic cardiovascular disease, including those who do not have diabetes.

5. Beta-blockers: New recommendations regarding the use of beta-blockers in patients with chronic coronary disease include the following: a) long-term beta-blocker therapy is not advised to improve outcomes in patients with chronic coronary disease in the absence of myocardial infarction within the previous year, left ventricular ejection fraction <50%, or another primary indication for beta-blocker therapy; and b) either a calcium-channel blocker or beta-blocker is advised as first-line antianginal therapy.

6. Cholesterol reduction: For individuals with chronic coronary disease, statins continue to be the first-line medication for cholesterol reduction. In some populations, a number of supplementary medications (such as ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, inclisiran, and bempedoic acid) may be utilised, albeit there are no clinical outcomes data for new drugs like inclisiran.

7. Antiplatelet medication: In many situations, shorter courses of dual antiplatelet medication are safe and effective, especially when the risk of ischaemic events is low to moderate and the risk of bleeding is high.

8. Dietary supplements: Given their ineffectiveness in lowering the risk of cardiovascular events, nonprescription or dietary supplements, such as fish oil and omega-3 fatty acids or vitamins, are not advised for usage in people with chronic coronary disease.

9. Routine testing: For the purpose of risk stratification or to direct treatment decision-making in patients with chronic coronary disease, routine periodic anatomic or ischaemic testing without a change in clinical or functional status is not advised.

10. Smoking cessation: Despite the fact that e-cigarettes enhance the chance of successfully quitting smoking compared to nicotine replacement treatment, e-cigarettes are not advised as the first-line therapy for quitting smoking due to the lack of long-term safety evidence and the dangers of continued usage.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.