Clinical Practice Variations in the Management of Ischemia With No Obstructive Coronary Artery Disease
Background Ischemia with no obstructive coronary artery disease is a condition associated with major adverse cardiovascular outcomes. To date, there are no specific American Heart Association or American College of Cardiology guidelines. The objective of this survey is to better understand the clini...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.022573 |
| _version_ | 1827976906931175424 |
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| author | Judy M. Luu Janet Wei Chrisandra L. Shufelt Anum Asif Benita Tjoe Paul Theriot C. Noel Bairey Merz |
| author_facet | Judy M. Luu Janet Wei Chrisandra L. Shufelt Anum Asif Benita Tjoe Paul Theriot C. Noel Bairey Merz |
| author_sort | Judy M. Luu |
| collection | DOAJ |
| description | Background Ischemia with no obstructive coronary artery disease is a condition associated with major adverse cardiovascular outcomes. To date, there are no specific American Heart Association or American College of Cardiology guidelines. The objective of this survey is to better understand the clinical practice and knowledge gaps that exist nationally. Methods and Results Participant‐specific links for a survey with 11 questions and 3 reminders were sent between September and October 2020 to the American College of Cardiology CardioSurve Panel. The panel consist of randomly selected cardiologists (n=437) who represent the current profile of the American College of Cardiology US membership. The survey received a 30% response rate. Of the 172 respondents, 130 (76%) indicated that they have treated patients with ischemia with no obstructive coronary artery disease. Although the majority (69%) are generally confident in their ability to manage this condition, 1 of 3 report lack of confidence or are neutral. The American College of Cardiology/American Heart Association Chronic Stable Angina Guidelines are the most commonly used reference for treating ischemia with no obstructive coronary artery disease (81%), with most cardiologists wanting additional clinical guidance, such as randomized controlled trials (61%). More than 4 of 5 cardiologists rarely or never order advanced imaging modalities to assess coronary flow reserve. Approximately 2 of 3 of respondents frequently prescribe statins (68%), aspirin (66%), calcium channel blockers (63%), and β blockers or α/β blockers (55%). However, nearly 70% never prescribe angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers. Conclusions This survey demonstrates heterogeneity in the management of ischemia with no obstructive coronary artery disease among US cardiologists, identifies support for guideline development, and outlines knowledge gaps for research and education in the therapeutic management of this condition. |
| first_indexed | 2024-04-09T20:56:00Z |
| format | Article |
| id | doaj.art-05bcb2b3da3c4f43a83d710a73c2926f |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T20:56:00Z |
| publishDate | 2022-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-05bcb2b3da3c4f43a83d710a73c2926f2023-03-29T18:35:57ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-10-01111910.1161/JAHA.121.022573Clinical Practice Variations in the Management of Ischemia With No Obstructive Coronary Artery DiseaseJudy M. Luu0Janet Wei1Chrisandra L. Shufelt2Anum Asif3Benita Tjoe4Paul Theriot5C. Noel Bairey Merz6Barbra Streisand Women’s Heart Center, Smidt Heart Institute Cedars‐Sinai Medical Center Los Angeles CABarbra Streisand Women’s Heart Center, Smidt Heart Institute Cedars‐Sinai Medical Center Los Angeles CABarbra Streisand Women’s Heart Center, Smidt Heart Institute Cedars‐Sinai Medical Center Los Angeles CABarbra Streisand Women’s Heart Center, Smidt Heart Institute Cedars‐Sinai Medical Center Los Angeles CABarbra Streisand Women’s Heart Center, Smidt Heart Institute Cedars‐Sinai Medical Center Los Angeles CAAmerican College of Cardiology Washington DCBarbra Streisand Women’s Heart Center, Smidt Heart Institute Cedars‐Sinai Medical Center Los Angeles CABackground Ischemia with no obstructive coronary artery disease is a condition associated with major adverse cardiovascular outcomes. To date, there are no specific American Heart Association or American College of Cardiology guidelines. The objective of this survey is to better understand the clinical practice and knowledge gaps that exist nationally. Methods and Results Participant‐specific links for a survey with 11 questions and 3 reminders were sent between September and October 2020 to the American College of Cardiology CardioSurve Panel. The panel consist of randomly selected cardiologists (n=437) who represent the current profile of the American College of Cardiology US membership. The survey received a 30% response rate. Of the 172 respondents, 130 (76%) indicated that they have treated patients with ischemia with no obstructive coronary artery disease. Although the majority (69%) are generally confident in their ability to manage this condition, 1 of 3 report lack of confidence or are neutral. The American College of Cardiology/American Heart Association Chronic Stable Angina Guidelines are the most commonly used reference for treating ischemia with no obstructive coronary artery disease (81%), with most cardiologists wanting additional clinical guidance, such as randomized controlled trials (61%). More than 4 of 5 cardiologists rarely or never order advanced imaging modalities to assess coronary flow reserve. Approximately 2 of 3 of respondents frequently prescribe statins (68%), aspirin (66%), calcium channel blockers (63%), and β blockers or α/β blockers (55%). However, nearly 70% never prescribe angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers. Conclusions This survey demonstrates heterogeneity in the management of ischemia with no obstructive coronary artery disease among US cardiologists, identifies support for guideline development, and outlines knowledge gaps for research and education in the therapeutic management of this condition.https://www.ahajournals.org/doi/10.1161/JAHA.121.022573anginaguidelinesischemia with no obstructive coronary arteriesischemic heart diseasenonobstructivestable coronary syndromes |
| spellingShingle | Judy M. Luu Janet Wei Chrisandra L. Shufelt Anum Asif Benita Tjoe Paul Theriot C. Noel Bairey Merz Clinical Practice Variations in the Management of Ischemia With No Obstructive Coronary Artery Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease angina guidelines ischemia with no obstructive coronary arteries ischemic heart disease nonobstructive stable coronary syndromes |
| title | Clinical Practice Variations in the Management of Ischemia With No Obstructive Coronary Artery Disease |
| title_full | Clinical Practice Variations in the Management of Ischemia With No Obstructive Coronary Artery Disease |
| title_fullStr | Clinical Practice Variations in the Management of Ischemia With No Obstructive Coronary Artery Disease |
| title_full_unstemmed | Clinical Practice Variations in the Management of Ischemia With No Obstructive Coronary Artery Disease |
| title_short | Clinical Practice Variations in the Management of Ischemia With No Obstructive Coronary Artery Disease |
| title_sort | clinical practice variations in the management of ischemia with no obstructive coronary artery disease |
| topic | angina guidelines ischemia with no obstructive coronary arteries ischemic heart disease nonobstructive stable coronary syndromes |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.022573 |
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