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The Diagnosis of Chronic Coronary Heart Disease
Christian Albus1, Jörg Barkhausen, Eckart Fleck
1Department of Psychosomatics and Psychotherapy, University Hospital Cologne, Cologne, Germany; Department of Radiology and Nuclear Medicine, Schleswig-Holstein University Hospital (UK-SH), Campus Lübeck, Lübeck, Germany; Internal Medicine/Cardiology, German Society of Cardiology (DGK), DGK Capital Office, Berlin, Germany; Philipps University Marburg, Department of General Medicine, Preventive and Rehabilitative Medicine, Marburg, Germany; Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany; Cardiology Practice, Munich, Germany.
Insights
Updated German guidelines recommend using non-invasive tests for chronic coronary heart disease (CHD) when pre-test probability is 15-85%. Invasive coronary angiography is reserved for cases with expected therapeutic implications, improving diagnostic efficiency.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Chronic coronary heart disease (CHD) is a prevalent condition, with a high number of cardiac catheterizations performed annually.
- Percutaneous interventions are common during these procedures, highlighting the need for optimized diagnostic strategies.
- Reducing invasive diagnostic procedures while maintaining diagnostic accuracy is a key objective in managing CHD.
Purpose of the Study:
- To present updated recommendations for the diagnostic evaluation of chronic CHD.
- To guide healthcare professionals in selecting appropriate diagnostic methods for patients with suspected CHD.
- To emphasize the role of non-invasive testing and selective use of invasive procedures.
Main Methods:
- Development of updated recommendations based on existing guidelines.
- Systematic literature review to inform the evidence base.
- Formal consensus process involving experts to approve the recommendations.
Main Results:
- Chronic CHD affects 8-11% of patients presenting to general practitioners and 20-25% to cardiologists.
- The Marburg Heart Score is recommended for general practitioners to estimate CHD probability.
- For pre-test probabilities between 15% and 85%, non-invasive tests are the primary evaluation method; angiography is reserved for cases with expected therapeutic implications.
Conclusions:
- Non-invasive testing and coronary angiography should be employed judiciously, based on expected therapeutic implications.
- Psychosocial risk factors, patient quality of life, and treatment adherence are crucial aspects of CHD evaluation and long-term management.
- These updated recommendations aim to refine the diagnostic pathway for chronic CHD, balancing accuracy with procedural necessity.
Background:
Chronic coronary heart disease (CHD) and acute myocardial infarction are endemic conditions. In Germany, an estimated 900 000 cardiac catheterizations were performed in the year 2014, and a percutaneous intervention was carried out in 40% of these procedures. It would be desirable to lessen the number of invasive diagnostic procedures while preserving the reliability of diagnosis. In this article, we present the updated recommendations of the German National Care Guideline for Chronic CHD with regard to diagnostic evaluation.
Methods:
Updated recommendations for the diagnostic evaluation of chronic CHD were developed on the basis of existing guidelines and a systematic literature review and approved by a formal consensus process.
Results:
8-11% of patients with chest pain who present to a general practitioner and 20-25% of those who present to a cardiologist have chronic CHD. General practitioners should estimate the probability of CHD with the Marburg Heart Score. Specialists can use detailed tables for determining the pre-test probability of CHD; if this lies in the range of 15% to 85%, then non-invasive tests should be primarily used for evaluation and treatment planning. If the pretest probability is less than 15%, other potential causes should be ruled out first. If it is over 85%, the presence of CHD should be presumed and treatment planning should be initiated. Coronary angiography is needed only if therapeutic implications are expected (revascularization). Psychosocial risk factors for the development and course of CHD and the patient's quality of life should be regularly assessed as well.
Conclusion:
Non-invasive testing and invasive coronary angiography should be used only if their findings are expected to have therapeutic implications. Psychosocial risk factors, the quality of life, and adherence to treatment are important components of these patients' diagnostic evaluation and long-term care.
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