F ASH
card
™
Stable Ischemic Heart Disease
Guideline-directed Medical Therapy for Relief of Symptoms
Recommendation Class of Recommendation Level of Evidence
Beta blockers should be prescribed as initial therapy for relief of symptoms
in patients with SIHD
CLASS I
Benefit >>>Risk
Procedure/Treatment
SHOULD be performed/administered
LEVEL B
Limited populations evaluated
Data derived from a single randomized trial
or nonrandomized studies
Calcium channel blockers or long-acting nitrates should be prescribed
for relief of symptoms when beta blockers are contraindicated or cause
unacceptable side efficts in patients with SIHD
CLASS I LEVEL B
Calcium channel blockers or long-acting nitrates, in combination with
beta blockers, should be prescribed for relief of symptoms when initial
treatment with beta blockers is unsuccessful in patients with SIHD
CLASS I LEVEL B
Sublingual nitroglycerin or nitroglycerin spray is recommended for immediate
relief of angina in patients with SIHD
CLASS I LEVEL B
Ranolazine in combination with beta blockers can be useful when
prescribed for relief of symptoms when initial treatment with beta blockers
is not successful in patients with SIHD
CLASS IIa
Benefit >>Risk
Additional studies with focused
objectives needed
IT IS REASONABLE to perform
procedure/administer treatment
LEVEL A
Multiple populations evaluated
Data derived from multiple randomized
clinical trials or meta-analyses
Ranolazine can be useful when prescribed as a substitute for beta blockers
for relief of symptoms in patients with SIHD if initial treatment with
beta blockers leads to unacceptable side effects or is ineffective or if initial
treatment with beta blockers is contraindicated
CLASS IIa LEVEL B
Treatment with a long-acting nondihydropyridine calcium channel blocker
(verpamil or diltiazem) instead of a beta blocker as initial therapy for relief
of symptoms is reasonable in patients with SIHD
CLASS IIa LEVEL B
Adapted from
2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. JACC 2012;60(24):1-121.
2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation 2012;126:e354-e471.
Disclaimer
is FLASHcard™ attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs
of primary care practice but also is applicable to providers at all levels. is FLASHcard™ should not be considered exclusive of
other methods of care reasonably directed at obtaining the same results. e ultimate judgment concerning the propriety of any
course of conduct must be made by the clinician aer consideration of each individual patient situation. Neither IGC, the medical
associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool.
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