Unstable Angina: Diagnosis and Management Commentary on the AHCPR Clinical Practice Guideline

by Crawford, Michael H.

• ISBN13: 9780412097713
• ISBN10: 0412097710
• Format: Paperback
• Copyright: 1997-01-02
• Publisher: Hodder Education Publishers

Summary

This volume is the first in a growing series of titles that provide the practitioner with a value-added product based on the Clinical Practice Guidelines entitled 'Unstable Angina: Diagnosis and Management' developed by the Agency for Health Care Policy and Research. This practical paperbackvolume provides recommendations to practicing primary care doctors, general internists, and nurse practitioners, on the evaluation and care of patients, focussing on decision-making and cost-effectiveness related to different treatments and therapies. Developed by a panel of private sectorclinicians and experts, this volume presents an impartial view from several practising physicians describing how the guidelines are used in daily practice. There is also explanation of how flexibility is necessary in interpreting the guidelines, where opinions in the fields differ and how thetheoretical guidelines compare to the reality of patient variability. Practical issues of managing the patient are also stressed.

Table of Contents

Preface	ix	(2)
Contributors Providing Commentary	xi	(1)
Guideline Development and Use	xii	(1)
Original Guideline frontmatter	xiii	(7)
Executive Summary	xx
Michael H. Crawford, M.D.
1. Overview	1	(24)
Michael H. Crawford, M.D.
Definition of Terms and Processes	1	(1)
Definition of Unstable Angina	1	(1)
Definition of Care Environments	2	(1)
Definition of Strength of Evidence Grading	2	(1)
Background Information on Unstable Angina	2	(16)
Unstable Angina in the Spectrum of Coronary Artery Disease	2	(5)
Process of Unstable Angina	7	(1)
Time-Dependent Mortality Risks of Unstable Angina	7	(2)
Diagnosis of Unstable Angina	9	(9)
Clinical and ECG Findings Related to Short-Term Prognosis in Patients with Unstable Angina	18	(1)
Factors Affecting Both Short- and Long- Term Prognosis in Unstable Angina	18	(1)
Computer-Based Risk-Stratification Models in Patients with Acute Ischemic Heart Disease	19	(6)
2. Guideline: Initial Evaluation and Treatment of Unstable Angina	25	(26)
Bruce K. Shively, M.D
Introduction	25	(1)
Objectives of Care	25	(3)
Approach to Care Objectives	28	(19)
Entry into Medical Care Directed by the Guideline	28	(3)
Stabilization and Initial Evaluation	31	(6)
Initial Treatment of Patients with Unstable Angina	37	(8)
Treatment and Assessment of Relief of Symptomatic Ischemia	45	(2)
Patient Counseling	47	(1)
Conclusion of Initial Evaluation and Treatment Phase	48	(1)
Medical Record	49	(1)
Duration of Initial Evaluation and Treatment Phase	50	(1)
3. Guideline: Outpatient Care	51	(8)
Michael H. Crawford, M.D.
Introduction	51	(1)
Objections of Care	51	(1)
Approach to Care Objectives	51	(6)
Diagnostic Assessment	51	(1)
Risk Stratification and Further Management	52	(2)
Outpatient Treatment of Symptoms	54	(3)
Patient Counseling	57	(1)
Medical Record	57	(1)
Duration of Outpatient Phase	58	(1)
4. Guideline: Intensive Medical Management	59	(26)
Michael H. Crawford, M.D.
Introduction	59	(1)
Objectives of Care	59	(1)
Approach to Care Objectives	60	(21)
Pharmacologic Management	60	(9)
Laboratory Testing	69	(4)
Assessment of Efficacy of Initial Medical Therapy	73	(3)
Evaluation and Management of Early Ischemic Complications	76	(5)
Preparation for Nonintensive Phase	81	(1)
Patient Counseling	81	(1)
Conclusion of Intensive Medical Management Phase	82	(1)
Medical Record	82	(1)
Duration of Intensive Medical Management Phase	83	(2)
5. Guideline: Progression to Nonintensive Medical Management	85	(4)
Michael H. Crawford, M.D.
Introduction	85	(1)
Objectives of Care	85	(1)
Approach to Care Objectives	86	(1)
Patient Counseling	86	(2)
Medical Record	88	(1)
Duration of Nonintensive Medical Management Phase	88	(1)
6. Guideline: Noninvasive Testing	89	(10)
Michael H. Crawford, M.D.
Background	89	(1)
Objectives of Care	89	(1)
Approach to Care Objectives	90	(8)
Selection of Noninvasive Tests	90	(4)
Use of Noninvasive Test Results in Patient Management	94	(4)
Patient Counseling	98	(1)
Medical Record	98	(1)
7. Guideline: Cardiac Catheterization and Myocardial Revascularization	99	(16)
Craig Timm, M.D.
Introduction	99	(1)
Objective of Care	100	(1)
Approach to Care Objectives	100	(13)
Cardiac Catheterization	100	(8)
Revascularization	108	(5)
Patient Counseling	113	(1)
Medical Record	114	(1)
8. Guideline: Hospital Discharge and Postdischarge Care	115	(8)
Michael H. Crawford, M.D.
Background	115	(1)
Objectives of Care	115	(2)
Approach to Care Objectives	117	(1)
Discharge Medical Regimen	117	(1)
Postdischarge Followup	117	(1)
Patient Counseling	118	(3)
Use of Medications	118	(1)
Monitoring Symptoms	118	(1)
Activity Level and Lifestyle Changes	119	(2)
Medical Record	121	(2)
References	123	(10)
Glossary	133	(6)
Acronyms	139	(2)
Index	141	(4)
Tear out algorithms	145