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

Abstract

Aim: The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease."

Methods: A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Structure: This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Keywords: ACC/AHA Clinical Practice Guidelines; acute coronary syndrome; air pollution; angina; antiplatelet therapy; aspirin; atherosclerosis; autoimmune diseases; cardiac events; cardiac rehabilitation; cardiovascular diseases; colchicine; coronary artery disease; coronary disease; cost-benefit analysis; depression; diabetes; diet; diet therapy; dietary supplements; drug therapy; dual antiplatelet therapy; environmental exposure; exercise tolerance; factor Xa inhibitors; fibrinolytic agents; glucagon-like peptide-1 receptor agonists; guideline-directed management and therapy; health care outcome assessments; health equity; heart disease risk factors; heart failure; hormone replacement therapy; hypercholesterolemia; hypertension; immunization; ischemic heart disease; mental health; multidisciplinary; myocardial ischemia; outcomes; outpatient; patient care team; pharmacology; pregnancy; proton pump inhibitors; quality of life; safety; secondary prevention; sexual behavior; sexual health; shared decision-making; smoking cessation; social determinants of health; sodium-glucose cotransporter 2 inhibitors; spontaneous coronary artery dissection; stress; therapeutic use; therapy; type 2 diabetes; vaccination.