Management of the Patient with Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
The patient asks about the source of the information that you have given him, and you explain it is a summary of a large analysis done at a university that included many studies on the benefits and harms of adding an ACEI and/or ARB to standard therapies for patients with stable ischemic heart disease and preserved LVSF. This information was summarized in a way that would allow patients to make decisions with their doctors regarding their course of treatment. You counsel him to take this guide (“ACE Inhibitors” and “ARBs” To Protect Your Heart? A Guide for Patients Being Treated for Stable Coronary Heart Disease) home to share with his family, refer to it from time to time to remind him why he's taking the drugs, and refer to it for descriptions of the adverse effects. After this discussion, you and your patient determine that the decreased risk of nonfatal heart attack, stroke, and death are worth the risk of possibly getting a cough, high levels of potassium, or suddenly fainting.
- Coleman CI, Baker WL, Kluger J, et al. Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II-Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease. Comparative Effectiveness Review No. 18 (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I). Rockville, MD: Agency for Healthcare Research and Quality; October 2009.
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