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Management of the Patient with Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

Slide: 4 of 21

Clinical Decision

Considering that the patient’s history of stable ischemic heart disease puts him at risk for future recurrent cardiac events and after considering current evidence and guidelines, is it reasonable to consider adding an ACEI to this patient's standard medical therapy?

Discussion of answers:

A. Correct. The updated metaanalysis in the CER titled, Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II-Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease supports the addition of an ACEI to the regimen of this patient to help lower his risk of future recurrent cardiovascular events.  In addition, ACC/AHA guidelines on management of patients with chronic stable angina  also suggest use of ACE inhibitors [Class IIa recommendation with level of evidence (B)] as a reasonable option in a patient like this. 

B. Incorrect. According to available evidence and updated guidelines, the addition of an ACEI to the regimen of this patient is a reasonable consideration at this time.