Chronic stable angina patient follow-up
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Overview
Patient follow-up is essential in monitoring symptoms and optimizing antianginal therapy. There are no specific guidelines on the frequency of follow-up but general recommendation is to follow up every 4-6 months during first year of therapy and then annually. Follow-ups may be scheduled early depending on patient symptoms response. Patient should be asked about their frequency and severity of symptoms, level of exercise capacity, whether patient has been able to modify his/her risk factors, how well is the patient tolerating the therapy and whether he/she has developed new illnesses or co-morbidities. Guidelines for imaging during follow-up visit are listed below.
ACC / AHA Guidelines- Echocardiography, Treadmill Exercise Testing, Stress Imaging Studies, and Coronary Angiography During Patient Follow-Up (DO NOT EDIT)[1]
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Class I1. Chest x-ray for patients with evidence of new or worsening congestive heart failure. (Level of Evidence: C) 2. Assessment of LV ejection fraction and segmental wall motion in patients with new or worsening congestive heart failure or evidence of intervening MI by history or ECG. (Level of Evidence: C) 3. Echocardiography for evidence of new or worsening valvular heart disease. (Level of Evidence: C) 4. Treadmill exercise test for patients without prior revascularization who have a significant change in clinical status, are able to exercise, and do not have any of the ECG abnormalities listed below in number 5. (Level of Evidence: C) 5. Stress imaging procedures for patients without prior revascularization who have a significant change in clinical status and are unable to exercise or have 1 of the following ECG abnormalities:
6. Stress imaging procedures for patients who have a significant change in clinical status and required a stress imaging procedure on their initial evaluation because of equivocal or intermediate-risk treadmill results. (Level of Evidence: C) 7. Stress imaging procedures for patients with prior revascularization who have a significant change in clinical status. (Level of Evidence: C) 8. Coronary angiography in patients with marked limitation of ordinary activity (CCS class III) despite maximal medical therapy. (Level of Evidence: C) Class IIb1. Annual treadmill exercise testing in patients who have no change in clinical status, can exercise, have none of the ECG abnormalities listed in number 5 above, and have an estimated annual mortality of >1%. (Level of Evidence: C) Class III1. Echocardiography or radionuclide imaging for assessment of LV ejection fraction and segmental wall motion in patients with a normal ECG, no history of MI, and no evidence of congestive heart failure. (Level of Evidence: C) 2. Repeat treadmill exercise testing in <3 years in patients who have no change in clinical status and an estimated annual mortality <1% on their initial evaluation as demonstrated by 1 of the following:
3. Stress imaging procedures for patients who have no change in clinical status and a normal rest ECG, are not taking digoxin, are able to exercise, and did not require a stress imaging procedure on their initial evaluation because of equivocal or intermediate-risk treadmill results. (Level of Evidence: C) 4. Repeat coronary angiography in patients with no change in clinical status, no change on repeat exercise testing or stress imaging, and insignificant CAD on initial evaluation. (Level of Evidence: C) |
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See Also
Sources
- 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, et al. 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. 1999; 99: 2829–2848. PMID 10351980
- ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Fihn SD, Fraker TD Jr, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Gibbons RJ, Alpert JS, Antman EM, Hiratzka LF, Fuster V, Faxon DP, Gregoratos G, Jacobs AK, Smith SC Jr; American College of Cardiology; American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients With Chronic Stable Angina. 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. 2003 Jan 7; 107 (1): 149-58. PMID 12515758
- ↑ Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Gardin JM, O'Rourke RA, Williams SV, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW; American College of Cardiology; American Heart Association; American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group. 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. 2007 Dec 4; 116 (23): 2762-72. Epub 2007 Nov 12. PMID 17998462