Patient profile based management approach for Optimal Treatment of Angina: a consensus from India cases

Authors

  • V. T. Shah Consultant Cardiologist, Diagnostic Clinic in Sion, Mumbai, Maharashtra, India
  • Geevar Zachariah Consultant Cardiologist, Mother Hospital Trichur Area, PO Pullazhi, Olarikkara, Thrissur, Kerala, India
  • S. Lakshmanan Consultant Physician, Priya Nursing home, Kappal Polu Street, Old Washermenpet, Chennai, Tamil Nadu, India
  • Surendra Babu Consultant Physician, Keerthana Clinic and Nursing home, Srinivasanagar Extn, Trichy, Tamil Nadu, India
  • K. Suresh Consultant Cardiologist, S. K. Hospital, Trivandrum, Kerala, India
  • Devanu Ghosh Roy Consultant Cardiologist, Peerless Hospital and B. K. Roy Research Center, Kolkata, West Bengal, India
  • Bhupesh Shah Interventional Cardiologist, Ahmedabad, Gujarat, India
  • Hemang Baxi Consultant Cardiologist, CIMS Hospital, Ahmedabad, Gujarat, India
  • M. P. Tripathi Consultant Cardiologist, Aditya CARE Hospitals, Bhubaneswar, Odisha, India
  • R. Saran Consultant Cardiologist, K.G. Medical University, Lucknow, Uttar Pradesh, India
  • Sajy Kuruttukulam Consultant Cardiologist, Medical Trust Hospital, M G Road, Ernakulam, Kerala, India
  • P. R. Vaidhyanathan Consultant Cardiologist, G. Kuppuswamy Naidu Memorial Hospital, Nethaji Road, Papanaickenpalayam, Coimbatore, Tamil Nadu, India
  • Peeyush Jain Director, Non-Invasive Cardiology and Head, Preventive Cardiology, Fortis Hospital, Okhla, Delhi, India
  • Rajiv Rajput Heart and Gynae Clinic H-21, Pocket-H, Market, Delhi, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20191174

Keywords:

Angina, CAD, Consensus, Case profiles, OMT, OPTA

Abstract

Chronic stable angina (CSA) is an incapacitating disorder. The pain can hinder the routine chores of an individual and significantly impact one’s quality of life (QoL). However, the good news is that this can be treated and the QoL can be improved. The key to apt management lies in the accurate early diagnosis of this condition, followed by a detailed evaluation and accordingly planned management, which should be regularly revised and be backed by an adequate follow-up. OPTA-OPtimal Treatment for chronic stable Angina-is an educational initiative to assist the clinicians in India with screening and diagnostic tools, strengthened by updated guideline-directed management to ensure satisfactory patient outcomes. OPTA aims to improve clinical outcomes by providing optimized pharmacotherapy for patients with stable angina. This expert consensus document intends to provide information for better understanding of the condition by clinicians and to ensure an early, accurate diagnosis, followed by optimal management of angina. For better clinical and practical understanding of Indian clinical scenario, the most commonly encountered patient profiles are briefly described here. These inputs and an extensive literature review were blended to develop the recommendations for clinicians across the country. An attempt is made to include clinical recommendations that meet the needs of the majority of patients in most circumstances in the Indian scenario. However, the ultimate judgment regarding individual case management should be based on clinician’s discretion. This expert consensus document is not a substitute for textbooks and/or a clinical judgment.

References

Pahlajani D. Management of stable ischemic heart disease - Current perspective. Available at: http://www.apiindia.org/pdf/medicine_update_2017/mu_202.pdf. Accessed Jun 12, 2018.

Ohman EM. Clinical practice. Chronic stable angina. N Engl J Med. 2016 Mar 24;374(12):1167-76.

Mishra S, Ray S, Dalal JJ, Sawhney JP, Ramakrishnan S, Nair T, et al. Management standards for stable coronary artery disease in India. Indian Heart J. 2016 Dec;68 Suppl 3:S31-S49.

Kohan L, Annex BH. Clinical outcomes of patients with stable angina. Available at: http://www.acc.org/latest-in-cardiology/articles/2015/05/28/09/03/clinical-outcomes-of-patients-with-stable-angina. Accessed May 4, 2018.

Sharma R, Bhairappa S, Prasad S, Manjunath CN. Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south Indian population. Heart India. 2014;2(3):65-69.

Rao M, Xavier D, Devi P, Sigamani A, Faruqui A, Gupta R, et al. Prevalence, treatments and outcomes of coronary artery disease in Indians: A systematic review. Indian Heart J. 2015 Jul-Aug;67(4):302-10.

SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015 Nov 26;373(22):2103-16.

Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017 Apr;23(Suppl 2):1-87.

Riddle MC, Bakris G, Blonde L, Boulton AJM, D’ Alessio D, Groot MD, et al. For American Diabetes Association. Standards of medical care in diabetes-2018. Diab Care. 2018;41(Suppl 1):s1-s155.

Degrauwe S, Pilgrim T, Aminian A, Noble S, Meier P, Iglesias JF. Dual antiplatelet therapy for secondary prevention of coronary artery disease. Open Heart. 2017 Oct 15;4(2):e000651.

Dézsi CA. Trimetazidine in practice: Review of the clinical and experimental evidence. Am J Ther. 2016 May-Jun;23(3):e871-9.

Banon D, Filion KB, Budlovsky T, Franck C, Eisenberg MJ. The usefulness of ranolazine for the treatment of refractory chronic stable angina pectoris as determined from a systematic review of randomized controlled trials. Am J Cardiol. 2014 Mar 15;113(6):1075-82.

Stone PH, Gratsiansky NA, Blokhin A, Huang IZ, Meng L; ERICA Investigators. Antianginal efficacy of ranolazine when added to treatment with amlodipine: The ERICA (Efficacy of Ranolazine in Chronic Angina) trial. J Am Coll Cardiol. 2006 Aug 1;48(3):566-75.

Camici PG, Olivotto I, Rimoldi OE. The coronary circulation and blood flow in left ventricular hypertrophy. J Mol Cell Cardiol. 2012 Apr;52(4):857-64.

Ferrari R, Camici PG, Crea F, Danchin N, Fox K, Maggioni AP, et al. Expert consensus document: A 'diamond' approach to personalized treatment of angina. Nat Rev Cardiol. 2018 Feb;15(2):120-32.

Nalbantgil S, Altintiğ A, Yilmaz H, Nalbantgil I I, Önder R. The effect of trimetazidine in the treatment of microvascular angina. Int J Angiol. 1999 Jan;8(1):40-3.

Kreatsoulas C, Crea-Arsenio M, Shannon HS, Velianou JL, Giacomini M. Interpreting angina: Symptoms along a gender continuum. Open Heart. 2016 Apr 28;3(1):e000376.

Garg P, Morris P, Fazlanie AL, Vijayan S, Dancso B, Dastidar AG. Cardiac biomarkers of acute coronary syndrome: From history to high-sensitivity cardiac troponin. Intern Emerg Med. 2017 Mar;12(2):147-55.

Bay M, Kirk V, Parner J, Hassager C, Nielsen H, Krogsgaard K, et al. NT-proBNP: A new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function. Heart. 2003 Feb;89(2):150-4.

Camici PG, Gloekler S, Levy BI, Skalidis E, Tagliamonte E, Vardas P, et al. Ivabradine in chronic stable angina: Effects by and beyond heart rate reduction. Int J Cardiol. 2016 Jul 15;215:1-6.

Giavarini A, de Silva R. The role of ivabradine in the management of angina pectoris. Cardiovasc Drugs Ther. 2016 Aug;30(4):407-17.

Tariq A, Zaman A. Management of stable angina in patients with type 2 diabetes mellitus. J Clin Prev Cardiol. 2014 Jul;3:73-84.

Fearon WF, Nishi T, De Bruyne B, Boothroyd DB, Barbato E, Tonino P, et al. Clinical outcomes and cost-effectiveness of fractional flow reserve-guided percutaneous coronary intervention in patients with stable coronary artery disease: Three-year follow-up of the FAME 2 trial. Circulation. 2018 Jan 30;137(5):480-7.

Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008 Oct 9;359(15):1577-89.

Mosleh W, Sharma A, Sidhu MS, Page B, Sharma UC, Farkouh ME. The role of SGLT-2 inhibitors as part of optimal medical therapy in improving cardiovascular outcomes in patients with diabetes and coronary artery disease. Cardiovasc Drugs Ther. 2017 Jun;31(3):311-8.

Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS- Guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012 Dec 18;126(25):e354-471.

Lipid-modifying drugs. Available at: https://www.nice.org.uk/advice/ktt3/chapter/evidence-context. Accessed Jun 12, 2018.

Fragasso G, Piatti Md PM, Monti L, Palloshi A, Setola E, Puccetti P, et al. Short- and long-term beneficial effects of trimetazidine in patients with diabetes and ischemic cardiomyopathy. Am Heart J. 2003 Nov;146(5):E18.

Ambrosio G, Mugelli A, Lopez-Sendón J, Tamargo J, Camm J. Management of stable angina: A commentary on the European Society of Cardiology guidelines. Eur J Prev Cardiol. 2016 Sep;23(13):1401-12.

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Published

2019-03-25