Regular Tests Not Required for Chronic Coronary Disease: American Heart Association
Highlights:
- AHA guidelines warn against unnecessary stress testing or CT scans in regular follow-ups for CCD patients
- AHA advises against the use of nutritional supplements for CCD due to lack of supporting evidence
- The new AHA guidelines recommend a limited use of beta-blockers in CCD management
Should people with long-term vascular and cardiac disorders, such as Chronic Coronary Disease (CCD), who have insufficient blood flow to or from the heart, be exposed to periodical screening with stress testing or a CT scan?
American Heart Association Guidelines for Chronic Coronary Disease (CCD) Care
The latest American Heart Association (AHA) guidelines warn against periodical unneccessary tests. According to the AHA, normal follow-ups do not require stress testing or a CT scan if the patient is on guideline-directed therapy and has not had any changes in symptoms or functional status. The AHA also advises against nutrition or nutritional supplements for persons with CCD, such as omega-3 fatty acids, vitamins C, D, or E, beta-carotene, or calcium (1✔).
"There is not enough evidence showing whether non-prescription nutrition or dietary supplements are beneficial for people with CCD," the non-profit organisation based in the US has said. Top cardiologists say the AHA guidelines are equally relevant to India.
Over Prescription and Unnecessary Tests Should be Avoided
Unnecessary tests and prescriptions of medicines, as well as nutraceuticals (foods that provide extra health benefits,for example, Green Tea) that have limited benefits, are widely prescribed. This should be reassessed in favour of emerging evidence, doctors say.‘New AHA guidelines for managing Chronic Coronary Disease advocate for less unnecessary screening and a shift in beta-blocker usage. Learn how this impacts you or your loved ones with CCD. #HeartHealth #CCD’
"While modern imaging modalities are a valuable advancement in cardiac care, there are several harms of indiscriminate universal cardiac imaging. Imaging tests like CT scan or radionuclide test exposes one to radiation. One CT scan is equivalent to getting 400 chest X-rays, thus one must be selective and discerning in using these tools," Dr. Ambuj Roy, professor of cardiology at AIIMS Delhi said. He added: "It's important for physicians to be abreast with recent studies/guidelines so that we can provide the best evidence-based medicine to patients."
Reevaluating the Use of Beta-Blockers in Chronic Heart Diseases
Beta-blockers, a class of medicine that decreases the heart rate and force of the heart's contractions thus lowering blood pressure, have been a cornerstone of managing chronic heart diseases. The new AHA guideline states that routine use of beta-blockers for longer than one year is not recommended in patients with CCD who have not had a heart attack within the past year or those who have left ventricular ejection fraction at or above 50%, meaning the heart is pumping blood effectively to meet the body's needs."There are general guidelines and principles that have been given by the AHA. However, I feel that physicians should follow a patient-centric approach. For example, stress testing or CT scan may not be required for routine follow-up in all but select patients, someone undergoing a high-risk procedure with a high possibility of complication shortly may still require undergoing tests at periodic intervals," Dr. Mohit Gupta, professor of cardiology at G B Pant hospital said.
The new AHA guidelines emphasise the need for healthy dietary habits and exercise for managing CCD. "Patients with CCD who are free from contraindications are encouraged to participate in habitual physical activity, including activities to reduce sitting time and to increase aerobic and resistance exercise," it states.
Reference:
- 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines - (https:www.ahajournals.org/doi/10.1161/CIR.0000000000001168)
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