Unstable Angina: Diagnosis and Management

Recommendations on the care of patients with unstable angina made in this clinical practice guideline are based on a combination of evidence obtained through extensive literature reviews and, in cases where evidence was lacking, on the consensus opinions of the expert panel. Principal conclusions of this guideline include:

• Many patients suspected of having unstable angina can be discharged home after adequate initial evaluation.
• Further outpatient evaluation of patients with symptoms of unstable angina judged at initial evaluation to be at low risk for complications should be concluded within 72 hours after initial presentation.
• Patients with unstable angina judged to be at intermediate or high risk of complications should receive aspirin, heparin, nitroglycerin, and beta-blocker therapy and should be hospitalized for careful monitoring of their clinical course.
• Intravenous thrombolytic therapy should not be administered to patients without evidence of acute myocardial infarction.
• Assessment of prognosis by noninvasive testing often aids selection of appropriate therapy.
• Coronary angiography is appropriate for patients judged to be at high risk for cardiac complications or death based on their clinical course or results of noninvasive testing.
• Coronary artery bypass surgery should be recommended for almost all patients with left main disease and many patients with three-vessel disease, especially those with left ventricular dysfunction.
• The discharge care plan should include continued monitoring of symptoms, appropriate drug therapy including aspirin and risk factor modification, and counseling.

Contents

• [Inside Front Cover]
• Guideline Development and Use
• Foreword
• Acknowledgments
• Panel Members
• Essential Definitions Related to Unstable Angina
• Executive Summary
• 1. Overview
  • Definition of Terms and Processes
  • Background Information on Unstable Angina
  • Factors Affecting Both Short- and Long-Term Prognosis in Unstable Angina
  • Computer-Based Risk-Stratification Models in Patients with Acute Ischemic Heart Disease
• 2. Guideline: Initial Evaluation and Treatment of Unstable Angina
  • Introduction
  • Objectives of Care
  • Approach to Care Objectives
  • Patient Counseling
  • Conclusion of Initial Evaluation and Treatment Phase
  • Medical Record
  • Duration of Initial Evaluation and Treatment Phase
• 3. Guideline: Outpatient Care
  • Introduction
  • Objectives of Care
  • Approach to Care Objectives
  • Patient Counseling
  • Medical Record
  • Duration of Outpatient Phase
• 4. Guideline: Intensive Medical Management
  • Introduction
  • Objectives of Care
  • Approach to Care Objectives
  • Patient Counseling
  • Conclusion of Intensive Medical Management Phase
  • Medical Record
  • Duration of Intensive Medical Management
• 5. Guideline: Progression to Nonintensive Medical Management
  • Introduction
  • Objectives of Care
  • Approach to Care Objectives
  • Patient Counseling
  • Medical Record
  • Duration of Nonintensive Medical Management
• 6. Guideline: Noninvasive Testing
  • Background
  • Objectives of Care
  • Approach to Care Objectives
  • Patient Counseling
  • Medical Record
• 7. Guideline: Cardiac Catheterization and Myocardial Revascularization
  • Introduction
  • Objectives of Care
  • Approach to Care Objectives
  • Patient Counseling
  • Medical Record
• 8. Guideline: Hospital Discharge and Postdischarge Care
  • Background
  • Objectives of Care
  • Approach to Care Objectives
  • Patient Counseling
  • Medical Record
• Acronyms
• Glossary
• Contributors
• Availability of Guidelines
• References

Suggested citation:

Braunwald E, Mark DB, Jones RH et al. Unstable Angina: Diagnosis and Management. Clinical Practice Guideline Number 10. AHCPR Publication No. 94-0602. Rockville, MD: Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute, Public Health Service, U.S. Department of Health and Human Services. May 1994 (amended).