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Apr 18, 2012

Choosing Your Heart Disease Treatment Wisely

Five things you should consider with your doctor when it comes to choosing the best treatment.

Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) Foundation, aimed at promoting conversations between physicians and patients that lead to better patient care. The hope is that by improving communication between patients and providers, patients can work together with their doctors to choose the best care for them that is supported by evidence, free from harm, truly necessary and does not duplicate other tests or procedures already received.

Recently, the American College of Cardiology released a list of “Five Things Physicians and Patients Should Question” as part of Choosing Wisely. Here are the five things that are recommended for physicians and patients to consider together:

  1. Don’t perform stress cardiac imaging or advanced non-invasive imaging in patients at low-risk for heart disease with no symptoms of a heart condition. This guideline will help eliminate unnecessary screenings in healthy patients, so that only high-risk patients needing such tests receive them.
  1. Don’t perform annual stress cardiac imaging or advanced non-invasive imaging at routine annual follow-up appointments with asymptomatic patients. In other words, patients without any cardiac symptoms do not need yearly tests, which could expose them to excess radiation and lead to unnecessary procedures. However, such tests may be warranted in patients without cardiac symptoms who had a bypass operation more than five years ago.
  1. Don’t perform stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery. This means that patients undergoing surgery unrelated to their heart, such as cataract removal, do not need advanced cardiac testing to ensure that they are fit for surgery.
  1. Don’t perform echocardiography as routine follow-up for patients with mild heart disease who have no change in symptoms. Patients with mild heart disease often go years without symptoms, and it is not until symptoms change that echocardiography is needed.
  1. Don’t perform stenting during percutaneous coronary intervention (PCI) in stable patients after a heart attack. Although this procedure is beneficial to many patients during PCI, stenting in stable patients after a heart attack may lead to increased risks and no significant benefits.

While these guidelines are meant to inform patients and providers about best practices to improve patient care, patients with any specific question about the items on this list should consult their physician.

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