Initial Assessment

All patients are different and should be evaluated according to their specific needs. To assist healthcare providers in determining care strategies for each patient, the American College of Cardiology Foundation (ACCF) and other professional societies have issued joint guidelines on diagnosing and managing patients with stable ischemic heart disease.2 Although CAD typically cycles through 4 clinically defined phases, the progression from 1 phase to another may vary for each patient.2

Risk assessment strategies may also vary according to a patient's clinical phase, but for patients with known CAD, there is no universally accepted approach.2

Suspected CAD
(May Be Phase 1 or 2)

For patients with suspected CAD, an initial clinical evaluation can help determine risk and diagnose CAD.2

Patients with chest pain may receive a thorough history and physical examination, a detailed assessment of symptoms, and determination of risk factors.2

Known CAD
(May Be Phases 1 to 3)

For patients with known CAD, a comprehensive clinical assessment can help determine risk and patient prognosis.2

In symptomatic patients, periodic follow-up assessments are important to reassess ischemic burden and determine effectiveness of any therapeutic regimens or risk factor modifications, particularly when the clinical status of the patient changes.2

Patients with CAD who have accelerating symptoms or decreasing functional capacity may require prompt reassessment.2

ACS (Phase 4)

Patients with ACS (including unstable angina or myocardial infarction [MI]) follow a different pathway and can be sent to the nearest appropriate emergency department for immediate care.2,3

Determining risk factors for patients with known or suspected CAD is an important part of the clinical evaluation. The more risk factors patients have, the greater their likelihood of a cardiac event.1